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to <br />( <br />TemperatureItem / Location.ocation <br />Food Safety Certification <br />F°F <br />Time in: <br />Name: <br />Exp. Date: <br />Chlorine: <br />Quat. Amm.: <br />PPm <br />PPm <br />Warewashing <br />Heat: <br />Other: <br />! Temperature <br />San Joaquin County <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.orq/ehd <br />°F <br />Yes No <br />Page |of U. <br />FOOD PROGRAM 0IR CONTINUATION <br />g) ifaw VO (W- <br />ItenVLocation <br />i __________ <br />Facility Hot Water Temperature <br />Hand Sink: -p <br />Warewashing Sink: <br />Phone: Ti/V-lelk’ ^>0^ <br />Time Out: <br />(n tj <br />U-W W - — <br />Wpto-------- <br />Tei^b-on^ 4 <br />Inspection Type: pg p/ f- <br />Re-Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE A,CTJONS <br />~fi) Oil/ xloidh. t <br />iWiG? <br />@ t-WA <br />7- <br />_______ Food Program Official Inspection Report <br />NameofFecllity: Aj 4^4^^/Yl Av <br />Address: K! SA~. ZIPC°de: C'1 <br />Owner/OperatoFT Q/AX 0 I <br />Program Element: 0-^ 53 Prograrn Record: <br />SB180 Posted Yes No Permit Posted <br />Received By / Title: <br />EH Specialist: U^\ <br />b:?TlAVf\_________ <br />EHD 16-24 (2'«pg) 4/3/13 <br />"....... <br />$A<(jvK ~~ <br />CM- IllWUe