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City: <br />no &ini-fr^r <br />€ <br />Item/Location Temperature Item / Location Temperature <br />Food Safety Certification <br />w: <br />CJ&<,gTnb\2C| -f-p <br />O,wa\i gWr <br />gung <br /> Cv£touz<>. fc/r <br />cXjS WVb dbg, £.toIW <br />KC CuStcV^S- <br />Name: <br />Exp. Date: <br />Warewashing <br />Heat: <br />Other: <br />ppm <br />PPm <br />- bio <br />Received By / Title: <br />EH Specialist: j <br />Time in: <br />°F <br />°F <br />Name of Facility: <br />Address: <br />Owner/Operator: <br />Program Element: <br />SB180 Posted Yes <br />Program Record: <br />Permit Posted Yes <br />San Joaquin Coi rv <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siqov.org/ehd <br />Y ft It Of Ttw spr-gg nod bodThS ~ <br />dVi£ yAndcws, Vgclrq <br />dPOA THl TcT' x.P-, ffYAEg QK. <br /> Qdjg wTb dhe, gnrrrtllg^ pg^rvACe ~\Q b <br />Phone: <br />Time Out: Page^of^ <br />FOOD PROGRAM 0IR CONTINUATION <br />FaciIity Hot Water Temperature <br />H a nd Sink: op |C h I o r i n e: <br />Warewashing Sink: ^|Quat. Amm.: <br />Food Program Official Inspection Report_______ <br />/>£nj(/r F\VMaf£X\£SS Wj) Da,e: t’llAfyy- <br />'b fotyi'rr w<%j Cit'': gpcrw ZipC°de:<%zdk <br />Telephone: <br />Program Record: ~ Inspection Type: ^A/jLfF <br />No Permit Posted Yes No Re-Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />- pgrAn olC cMva W, -fed (stT 'Pb <br /> <br /> <br /> <br />ydfYfcr cm>P Vunnld W-______. <br />ccaahw^ dee? trUu foezk. twcM <br />,rj Gfr1<W€