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Cit*: t(YU <br />1 <br />( <br />c <br />Temperature TemperatureItem / Location <br />Food Safety Certification <br />CF <br />iw«ra <br />zY'.JIEfflll <br />Name: <br />Exp. Date: <br />J|____ <br />Chlorine: <br />Quat. Amm.: <br />PPm <br />PPm <br />Warewashing <br />leat: <br />)ther: <br />HIP OMChO oj >1- <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 />AND CORRECTIVE ACTIONS <br />pprn <br />idopp'iuuq-ui^ - <br />- <br />Page^of . <br />FOOD PROGRAM 0IR CONTINUATION <br />_______ ________ OBSERVATIC <br />CTHwo yioWi <br />Phone: <br />Time Out: <br />EH Specialist: <br />Time in- /7J j V\ <br />°F <br />°F <br />Facility Hot Water Temperature <br />land Sink: pp <br />i/arewashing Sink: <br />Food Program Official Inspection Report <br />ve^\\aJ\ . , Date: <br />Zip Code: p- j <br />Telephone: | <br />inspection Type: -fP^ 0 <br />Re-lnspection on or After: <br />-) X:-'. ICCypjO <br />____ <br />Program Record: C\ <br />Permit Posted Yes No <br />Name of Facility: | <br />Address: <br />Owner/Operator: <br />Program Element: I I oZ4^ <br />SB180 Posted Yes No <br />Received By/Title: <br />■ U/oE <br />EHD 16-24 (2'">pg) 4/3/13