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w: <br />fCity: <br />7- <br />'^S <br />JL <br />Temperature <br />Certification1 Chlorine:M Quat. Amm.:ppm <br />Phone: <br />Aw/<ktZr- 10V <br />( /a ~~ f <br />Name: r. <br />Exp. Date: <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 />C,’/ CZ> <br />EHD 16-24 (2n0pg) 4/3/13 <br />Received By/Title: <br />EH Specialist: <br />Time in: <br />Item/Location <br />°FOther: <br />Program Record: <br />Permit Posted <br />Page jof <br />FOOD PROGRAM 0IR CONTINUATION <br />°F <br />Temperature <br />°F <br />Yes No <br />Warewashing <br />ppm |Hea” <br />[ Facility Hot Water Temperature <br />Hand Sink: °p <br />Warewashing Sink: <br />C7^:\ 3m7 <br />Time Out: <br />0 <br />■•-. c*^! vs <br />___I <br />y /Zc _______ <br />/ r _____ <br />C _______ <br />______ /. I ebtf rd~ " <br />(/r <br />•______(Aft ,. <br />_____f d <br />c--y <br />■ <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />L^.;/ L< <br />(dtp''—A 7 /\d-~ <br />^2. __ <br />/// <br />Xc ___ <br />_ <br />______---------------------------------_ <br />----- <br />Food Program Official Inspection Report <br />r^pt ________________________________Date: <br />£ City: ZipCode: <br />Telephone: <br />Inspection Type: <br />Re-Inspection on or After: <br />______ <br />S'* ddp <br />Item / Location <br /> <br />b _ <br />3qa/ /2J __ <br />'LA <9C tyfSC'iol y <br />I 2L - LSLf^------ <br />Cl_____ <br />IAIK rtfry/Ly V _^A <br />nd fvT ^^7" <br />k__£LeA <br />4— Z/y <br />-------- <br />Name of Facility: / ?• ’ <br />Address: <br />Owner/Operator: <br />Program Element: <br />SB180 Posted Yes No