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/ <br />Zip Code:Lo fi <br />Telephone: <br />Program Record:Program Element: <br />Permit Posted YesSB180 Posted <br />IS <br />2111 <br />a) M r) <br />o <br />TemperatureItem / Location <br />Food Safety Certification <br />Name:Chlorine:PPm <br />ither:'arewashing Sink:Exp. Date:PPm <br />Received By / Title: <br />Phone:EH Specialist: <br />9ofTime Out:Time in: <br />EHD 16-24 (2nOpg) 4/3/13 <br />—r------ <br />9^ <br />Warewashing <br />(Heat: <br />LC' P I <br />£> *yr Clty: <br />Quat. Amm.: <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 />°F <br />Page 7i <br />FOOD PROGRAM 0IR CONTINUATION <br />Item/Location <br />Food Program Official Inspection Re_port <br />Date: <br />OBSERVATIONS AND CORRECTIV£ACT!ONS <br />___* <br />S3 <br />---------1------- <br />°F <br />°F <br />1 Kt-Skjj <br />ysj O /2~ <br />//jT /OGf <br />Facility Hot Water Temperature <br />Hand Sink: <br />> / zzrz?-/v <br />-hh i r'SiLy— <br />—3—/-c/'SKS < <br />-—‘yn1 <br />Yes No <br />I- ^l-1 -AS e <br />i ~_ co <br />Temperature <br />Name of Facility: <br />Address: <br />Owner/Operator: <br />? (<050^9^7 <br />No <br />Inspection Type: <br />Re-Inspection on or After: <br />C c/q f j fit? <br />______3 f w <br />®3±EEi <br />cr\ - A /? C <br />/ dO ~/Gr7' A <br />i c/C) i'/ S’ / n KGG <br /><5;