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&=><=> <br />/a> <br />CTA/L <br />/() <br />z^TT/k /7/Z <br />I Temperature TemperatureItem / LocationItem/Location <br />Food Safety Certification <br />Name:Chlorine: <br />Quat. Amm.:FExp. Date:PPm <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 />Other: <br />Name of Facility: <br />Address: <br />Received By / Title: <br />EH Specialist: / <br />Time in: <br />Program Record: <br />Permit Posted <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />°F <br />Pagen of <br />FOOD PROGRAM 0IR CONTINUATION <br />°F <br />Facility Hot Water Temperature <br />Hand Sink: <br />Warewashing Sink: <br />PHO SO 32.-75 <br />Yes No <br />Owner/Operator: <br />Program Element: <br />SB180 Posted Yes No <br />_________________ <br />_____________Phone: <br />/O ____________________ T-.meOut: <br />EHD 16-24 (2rOpg) 4/3/13 <br />Warewashing <br />ppm |Heat: <br />Z O) h/ I' <br />A/ _______ _______________________ <br />/S~o^ <br />X3 i r a <br />VC) rP! I c H’PShP Sj* <br />12.)^ -To <br />1 £ H3r.bi H °T <br />^5) /Z/gr — <br />y , P/ A Hd c da ______ <br />Food Program Official Inspection Report_______ <br />/Ma MT S' Ctf- OUKRkSE PU^PKItP FfilKF. Date: /4?--/?Y-2,S <br />________________________City: /Yi^fVTEcP zlpCode:__________ <br />Telephone: <br />inspection Typey-^ 51/f^T <br />Re-Inspection on or After: <br />0 (L_P <0 <br />/(JU / ° d CtZ / <br />ZZ^_-______ <br />uspe <3'/ <br />ZY 0 L P^ZkI C, /