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City: <br />Telephone:Owner/Operator: <br />Inspection Type: <br />Re-Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />Temperature| Temperature ||Item / LocationItem/Location <br />Food Safety Certification <br />Name:ppm <br />Other:Quat. Amm.:Warewashing Sink:Exp. Date:PPm <br />Received By / Title: <br />Phone: <br />Time Out: <br />EHD 16-24 (2"° pg) 4/3/13 <br />Chlorine: <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 />Warewashing <br />Heat: <br />Name of Facility: \ <br />Address: <br />SlSM S2/I bZ SMV, <br />Yes No <br />°F°F <br />°F <br />Facility Hot Water Temperature <br />Hand Sink: °p <br />Food Program Official Inspection Report_____ <br />Date: 2 3, '2~ <br />Zip Code: <br />Program Element: o , Program Record: <br />SB180 Posted Yes No Permit Posted <br />71 <br />EH Specht: . <br />Time in: <c—-<O \ I SpKA Page<°f <br />FOOD PROGRAM 0IR CONTINUATION