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S/1'1^7 <br />City: <br />^UL <br />t) I <br />+= <br />Food Safety Certification <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 />i <br />Q|6 <br />■ogram Record: <br />Yes <br />Name: <br />Exp. Date: <br />Chlorine: <br />Quat. Amm.: <br />Date: <br />Zip Code: <br />Telephone: <br />PPm <br />PPm <br />°F <br />°F <br />Warewashing <br />Heat: <br />Other: <br />ZBEHEJl <br />No <br />C{/VVy\. WW\wvty j <br />Item / (location <br />Facility Hot Water Temperature <br />Hand Sink: op <br />Warewashing Sink: op <br />J Phone: <br />J Time Out: Q Page^of <br />FOOD PROGRAM 0IR CONTINUATION <br />Food Program Official Inspection Report <br />—tsJ—| <br />__SMC <br />Progra <br />No Permit Posted <br />/if}h^\ -* <br />Temperature <br />__________OBSERVATIONS AND CORRECTIVE ACTIONS <br />f -fk> tl^Uvv CvVyy vvvvvvxATlq E I VcCvVv^\ - l/V \ i <br />— (lg i2 r z <br />VV Y'l (A.U <br />Temperature <br />Name of Facility: <br />Address: <br />Owner/Operator: <br />Program Element: <br />SB180 Posted Yes <br />XA-j <br />VMVk IV I _____ <br />iAA (W fo h <br />~ci/\AAV\A)f < Ct^cpfU/ H f <br />Up A, ' 4 <br />_■ c fy/vvv\h?* - <br />tOOV ' - ^v, <br />QIC kAi/4 j > 3F <br />Item/Location <br />iA/xtfr - kiU^Cz" 4A. VVyikU uyUA-yy- <br /><3,AA^ Cz(, vv\1ma -1 (Ayi^yv^/ c I\ Unvv\)_____ <br />v /ill v oEUxy <br />vvvkt— 43^ <br />Received By / Title: <br />EH Specialist: C~t <br />Time in: ( Q <br />EHD 16-24 (2™>pg) 4/3/13 <br />Inspection Type: <br />Re-Inspection on or After: ’ <br />— (lg S L 12 - ^/LAA-LL • <br />f*y^u kuE EeA v[?~ <br />- I)/- ll^k <br />_ OWA/v W^ <br />u) IAMjIWI <br />//ViJU <br />_________