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<br />7AJsl <br /> <br /> 9/^-u <br />TemperatureItem / Locationitem/Location <br /> <br />Food Safety Certification <br />ppm <br />Other:'arewashing Sink:PPm <br />i Temperature— <br />Name: <br />Exp. Date: <br />Chlorine: <br />Quat. Amm.: <br />SI <br />___h/-^ <br />LM J <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 />EHD 16-24 (2nd pg) 4/3/13 <br />/ Z.<y 7 <br />___ <br />T P-u E- <br />bl A T <br />Received By / Title: <br />EH Specialist? <br />Time in: <br />Warewashing <br />Heat: <br />Pagef of <br />FOOD PROGRAM 0IR CONTINUATION <br />°F <br />°F <br />°F <br />Food Program Official Inspection Report_______ <br />Pate: - 2. g- <br />Zip Code: <br />Telephone: <br />Inspection Type:-^^ p <br />Re-lnspection on or After: <br />________________________________ <br />Phone: 5^/- <br />TimeOut: J /^/)Q ’ <br />Program Record: pQO ~7 3 <br />Permit Posted Yes No <br />Facility Hot Water Temperature <br />Hand Sink: <br />Owner/Operator: <br />Program Element: / <br />SB180 Posted Yes No <br />s <br />Name of Facility: M T 5 C/f- S U R <br />Addteas: cily: fj TEC/p <br />\a($ <br />/ LLggAgf^- <br />u?1^i tJ+'T' <br />i-)p g. <br />__3 ~f ~ •*T~ <br />-s c-j if1 M q 1^ <br />3_____________ <br /> (?y <br />S' jjfcJLK (jAZ- <br />100-/=^ C ZV C dKi. <br />> Q yg p <br />o f <br />i o 4 <br />I <D O <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />/Cf rKF^A/1 7-/<dck / <br />- HIP <br />( LA /SJ) I ° P <br />— fs/co =*