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ci,y: StocH^ <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />Qb W-.fc^rySsb <br />fidjuSt to loo-loaK <br />pjscata -puybArS ex <br />Food Safety Certification <br />Name:ppm <br />Other:Exp. Date:Warewashing Sink:Quat. Amm.:PPm <br />EHD 16-24 (2,apg) 4/3/13 <br />Received By / Title: <br />EH Specialist: <br />Time in: O . Ajzl <br />Name of Facility: <br />Address: <br />Warewashing <br />Heat: <br />Page /of y <br />FOOD PROGRAM OIR CONTINUATION <br />Temperature <br />_r <br />Chlorine: <br />fafi. <br />I Location <br />\n a W <br />°F°F <br />6) figua wccg I <br />- w~ yvcMgr <br />'0^ <br />°F <br />Temperature <br />Phone: y(_p[- <br />TmeOut: <br />Facility Hot Water Temperature <br />Hand Sink: op <br />\30 v"< <br />AC <br />Owner/Operator: <br />Program Element: <br />SB180 Posted Yes <br />in c\ <br />13^ E <br />San Joaquin Co ty <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, GA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siqov.org/ehd <br />___ . go <br />bz)V D£yF\jr- TZMP ~I <br />* Item / Lc <br />'Ifirne <br />^3) hccyO fcz-.' <br />- TrdrdvoSh fs Qt <br />Food Program Official Inspection Report_______ <br />g-y. Wxppor Date: nTrq/n- <br />^j>\ S- GgtrfWl City: StPOFt^ ZipCode: Qc^ie, <br />KlY-isW ccWurirtv| Telephone:yd3 <br />11/^ Program Record: g, ^^2 Z\ \Z________________________Inspection Type^^p <br />No Permit Posted Yes No Re-Inspection on or After: <br />(^) _____________ <br />- 7- Hr fiKtgricwa <br />or WW - <br />____________________________ <br />d) ?'W(/wiq^s <br />7^' '■