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city: <br />Item / Location <br />Food Safety Certification <br />ither: <br />Name: <br />Exp. Date: <br />Phone: <br />Time Out: <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.orq/ehd <br />zz <br />°F <br />°F <br />(ph \( /g Ti -TO Paai/MM <br />Pag^ of t_| <br />FOOD PROGRAM OIR CONTINUATION <br />Warewashing <br />ppm HHeat: <br />ppm <br />| Temperature <br />Program Record: <br />Permit Posted Yes No <br />Name of Facility: <br />Address: <br />Owner/Operator: <br />Program Element: T <br />SB180 Posted Yes <br />I Temperature <br />Ichlorine: <br />op Quat. Amm.: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />(i4)flhY> lAUUYWS J <br />\hCS ('Mufds <br />-J k* <br />Food Program Official Inspection Report <br />WfotWIlT) WH !/?<i ....... Da,e: ip'; ~ <br />. i _ -.--IV--’ ------ Zip Code: r, <br />_____________Telephone: <br />InspeotlonTypei^gyy^ <br />Re-Inspection on or After: <br />Lfcnpn g, <br />No <br />EP TO)0(Wi <br />torni cm <br />__g-H 00 <br />-WiEC/ bfpbh — <br />g)U)(Wiv/( tfe-ro^ <br />W W - tfs 1(720^-' oj <br />j/OhMuS TO^ib(,QS ^roppryi <br />h/U4flwff> to llMfcP <br />' J Item/Location <br />I - _ <br />Facility Hot Water Temperature <br />Hand Sink: °F <br />Warewashing Sink: <br />Received By / Title: <br />EH2pedaiisLW®v _ <br />Tirndn: d (Y\ ' ____________ <br />EHD 16-24 (2nopg) 4/3/13