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w; pi <br />EqD Zip Code:City: <br />Program Record: <br />Re-Inspection on or After:Permit PostedSB180 Posted <br />.. OBSERVATIONS AND CORRECTIVE ACTIONS <br />i Temperature TemperatureItem / LocationItem/Location <br />:hlorine:ppm <br />Other:mat. Amm.:arewashing Sink:°FFppm <br />Time in: <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 />°F <br />Phone: <br />Time Out: <br />Warewashing <br />Heat: <br />PageZ>of <br />FOOD PROGRAM 0IR CONTINUATION <br />Facility Hot Water Temperature <br />Hand Sink: op <br />Name of Facility: <br />Address: J) <br />Owner/Operator: <br />Program Element: <br />Yes No Yes INd" <br />Food Safety Certification <br />Exp. Date: <br />Telephone: <br />Inspection Type: --fy p <br />Received By/Title: <br />EH Specialist: H <br />EHD 16-24 (2™ pg) 4/3/13 * <br />frlMF cl lULvyrn <br />Food Program Official Inspection Report