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City: <br />uW-~ <br />No <br />J) <br />Temperature <br />Food Safety Certification <br />of <br />FOOD PROGRAM OIR CONTINUATION <br />San Joaquin County <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 />PIM9-I1U73 <br />No <br />Name: <br />Exp. Date: <br />Chlorine: <br />Quat. Amm.: <br />ppm <br />PPm <br />°F <br />°F <br />Warewashing <br />Heat: <br />Other: <br />i___________|| Facility Hot Water Temperature <br />|Hand Sink: op <br />jWareWashing Sink: <br />/ 7 T* Phone: <br />TimeOut: 4) /< ' <br />jcvr <br />Name of Facility: <br />Address: <br />Owner/Operator: <br />Program Element: <br />SB180 Posted Yes <br />fohoA nW) <br />I Ski J _______ <br />Item/Location <br />Food Program Official Inspection Report <br />/-z- Date: <br />____________________—___________________ZipCode: <br />Telephone: <br />4 j _____Program Record:___________________________________________Inspection Type: <br />No Permit Posted Yes No Re-Inspection on or After: <br />________________ ________OBSERVATIONS AND CORRECTIVE ACTIONS <br />kj^Tl^ v|TCjzj<X-A. CtVwvwwwG v^~\ <br />‘ \A /-^f dltttL&xkj \dlwlo' <br />1 IfV <br />i ________ x__________________________________ ________ ____ ________________ <br />j (j 04 <br />£4^________________________________ <br /> \/ 'fauK ' - ptoJ far /rp iwF <br />STI iCUva - v <br />fill A Ql/\^ 1 |/<( _ b RdV-l wv CcVvyyVWyvtr <br />Jx I fri ^V i (A^ t£ yL f c z / r/4 / c^tk) <br />[h f lAT^yv^ lAific^y lllF. favvytzJ <br />fii(d.ktA^ 'L^VyiflV^ [Ck^MM <br />^krTikl ph ^44)fa f/A/(>4 ______ <br />j y 'hzlaU ■ Phm df ~~ <br />/z /g cdik <br />- j ) (kuw cbpk.___________________________ <br />' ijr |r /— <br />Temperature ' Item I Location 1 Temperatur <br />'• <br />Received By / Title:/'y/1 <br />EH Specialist: IQ <br />Time in: , ., • ,,,[ I). vO <br />EHD .16-24 (2"dpg) 4/3/13 <br />TL<> 1<W <br />//Au ( r ‘ ‘ <br />SvyLlfa? -tSf frWlA f <br />C^( / G/!> *A A ki i\ G p c hdi <br />________F> Hi6V-'|v\A C^Vyyyvvvw/t/Li <br />yv r \rWig ywc t <br />i/v^i/vyj lA/fic^y tnT~T <br />fk) p>vp ^cctAH/y pf~ Ifcfihk <br />„ |\A <br />fa /cc- <br />tvkkni