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Zip Code:Address: <br />Telephone: <br />Program Record:Program Element: <br />Permit PostedSB180 Posted Yes No <br />7 <br />5 * <br />| Temperature Item / L Temperature <br />Food Safety Certification <br />Chlorine:FName:PPm <br />>ther:Quat. Amm.:'arewashing Sink:Exp. Date:PPm <br />EH Specialist: <br />Time in: <br />Warewashing <br />iHeat: <br />Z <br />_________a/.-? <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 />A. <br />Owner/Operator: <br />°F°F <br />Received By/Title: " /"^ <br />EHD 16-24 (2«pg) 4/3/13 <br />Facility Hot Water Temperature <br />Hand Sink: °p <br />Yes No <br />-1) /i V) y 5 <br />phonc Z/?y i^5o^ <br />Time Out: Page^ of <br />FOOD PROGRAM 0IR CONTINUATION <br />Agency <br />inspection Type: 7^, zj <br />Re-Inspection on or After: / <br />| (TP /Z7 <br />7 ^5- <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />iff Ct <br />------------------------------ <br />//tf <br />_______1 /Vq ______—__ <br />(3) xZwA A- <br />/kF. ,/lZ <br />------------------/\/c7 U <br />tJO ,___________ <br />Y0 i/\ . L&rJ (otI <br />- <br />Yc? p7~p! 15^ Xv^F <br />— <br />Item/Location <br />(yi c/x <br />_______ Food Program Official Inspection Report <br />Name of Facility: /ff /C^l^ [0 ~0 <br />7 ^Lczyi /y/) duZt