Laserfiche WebLink
U:- <br />—-X U o l <br />^Y"- <br />13Z F <br />^Wv- < <Z^€Yy\,CA <br />3 <br />C I ' <br />cation <br />V4 20 <br />Food Safety Certification <br />Name:°F <br />ither:Warewashing Sink:krnm.:Exp. Date:°F°F PPm <br />Received By / Title: <br />^2 <br />San Joaquin Coun. . <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 />5OS%°1 <br />Yes No <br />Name of Facility: <br />Address: o < <br />Page; of <br />FOOD PROGRAM 0IR CONTINUATION <br />I V Cy-^JV i. VATL'd rv <br />FxjO <br />~ OL)\p^r> ca V)nj cFF A <br /><ry V. <br />Warewashing <br />” ppm ||HeatT <br />Tlm<"n: lOlScMYX________________ <br />EHD 16-24 (2nd pg) 4/3/13 <br />Temperature <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />Cy- <br />- pW-j \\Qr <br />nJO</~~vA4? <br />Item/Location <br />2- <Aa V-Vo-X^ <br />n CZ F ( -F-CA^ CK-/2- <br />Food Program Official Inspection Report______ <br />, VWaAF FyA Date: io-b-i£) <br />S F a City: UjZ-JU__________Zip Code: Ct^^Q <br />Owner/Operator: —I i/A_____________________________________________________Telephone: <br />Program Element: C| Program Record: __________________________Inspection Type: <br />SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br />(' ~w u cM <br />VZ-F f— <br />Temperature <br />R______ <br />r________ <br />124 r_______ <br />| Facility Hot Water Temperature <br />Hand Sink: op <br />ykjCV'—I'YA X? <br />1 p-cTC^ <br />X-L tr rTZ <br />t. Ai7 <br />Time Out: <br />><3^? z norY-yj vX-yF