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w: <br />Zip Code:City:____ <br />Telephone: <br />Inspection Type:Program Record:Program Element: <br />Re-Inspection on or After:Yes NoPermit PostedYesNoSB180 Posted <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />Ik <br />LJ- <br />1_ <br />1£a <br />_ <br />-7^ <br />T’ <br />i h ,—i <br />Temperature TemperatureItem / LocationItem/Location <br />Food Safety Certification <br />FName:ppm <br />>ther:Quat. Amm.:arewashing Sink:°FExp. Date:F ppm <br />V 1AAReceived By/Title: <br />Phone:EH Specialist: <br />Page ofTime Out:Time in: <br />FOOD PROGRAM OIR CONTINUATION <br />|______ <br />Chlorine: <br />-lr <br />- ( 7^ <br />I( <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 />Name of Facility: <br />Address: <br />Warewashing <br />leat: <br />A r <br />' ! <br />EHD 16-24 (2nd pg) 4/3/13 <br />Food Program Official Inspection Report_____ <br />Oate: < y ?/? <br />X- x-e-/ A <br />Facility Hot Water Temperature <br />land Sink: °p <br />A-r -i '-2 <br />ly,..1 ( <br />7/ <br />w i jV;*. <br />5 'f < -./ 1 -i/ <br />Owner/Operator: