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City: <br />26 , <br />'Z-f. <br />37 <br />6 <br />M- <br />33 <br />■2S. <br />/u>^r' <br />6- ~-7F <br />3k <br />Temperature TemperatureItem / LocationItem/Location <br />Food Safety Certification <br />Name:F <br />Other:Quat. Amm.:Warewashing Sink:Exp. Date:PPm <br />v <br />PaTime in: <br />FOOD PROGRAMEHD 16-24 (2"° pg) 4/3/13 <br />Received By/Title:' <br />EH Specialist: r- <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 />/ /If <br />Name of Facility: <br />Address: <br />Program Record: <br />Permit Posted <br />Inspection Type: <br />Re-Inspection on or After: <br />S C(/\O Z <br />37. <br />/b^r <br />No <br />°F <br />g>,/x 3x3/4 <br />°F <br />1 <br />Yes No <br />Pho"e: 2- <br />Time Out: <br />\____________ <br />_____hmJC'^' <br />_____________ <br />Facility Hot Water Temperature ________ <br />Hand Sink: -p Chlorine: <br />Owner/Operator: <br />Program Element: <br />SB180 Posted Yes <br />Food Program Official Inspection Report <br /><7r//-/ Date: 1^1 <br />_________________________________CltV: _____________Zip Code: y0 <br />Telephone: <br />QAr _________ <br />______ <br />C,o^ S_________ <br />Jc .C^i "y_________ <br />(Ay <br />--------------- <br />----------- <br />---------------------------- <br />/De ' <br />CV 6/____________ <br />Warewashing <br />ppm Heat: <br />4t<v\z /) <br />-7< - <br /><^_ i/t/ <br />Z,//1 <br />.J f1 .yc ___ <br />'U. cl '■y <br />4-&-^ <br />- <br /><4^ ------- <br />5 5~- AZ <br />______T 6 <br />l^^cC C-L,^ -/yP <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />, /Li''/ ______________ <br />A • *K v «> <br />H - > A ______ <br />Cs'tP/'i.^ £"/ Cyt____( X A~C’ Z <br />'— /A--0 t zt <br />_______///< <br />— <br />■C^J'___________