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Zip Code:City: <br />Telephone: <br />Inspection Type: TProgram Record: <br />Permit PostedSB180 Posted <br />I- <br />A-/t <br />■- <br />Item / LocationTemperatureItem/Location <br />Food Safety Certification <br />Chlorine:°FName:ppm <br />Other:Warewashing Sink:Exp. Date:ppm <br />Phone: <br />Time Out:Time in: <br />FOOD PROGRAM OIR CONTINUATIONEHD 16-24 (2™ pg) 4/3/13 <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 />Quat. Amm.: <br />________ <br />Received By/Title: k <br />EH Specialist: <br />A’ <br />w: f <br />Owner/Operator: <br />Program Element: <br />Name of Facility: <br />Address: <br />Warewashing <br />Heat: <br />iTemperature <br />2__ <br />Page of <br />°F °F <br />q 0 .. \ /^y o <br />Facility Hot Water Temperature <br />Hand Sink: <>p <br />-T- <br />[ obserVx <br />\/$c - iz <br />i <br />---------------------- <br />r> .rs <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />\z AM <br />Food Program Official Inspection Report <br />z Date: Z/?/2yiK / e V V C Citv: Zio Code: / <br />^>7) <br />/7x c/s 7 ___ <br />Yes No Re-Inspection on or After: <br />zm <br />Yes No <br />\ / f2c) "f' - / O'i ~~ 4^) 4?/a,