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■V <br />1 <br />4= <br />trvT^— <br />\i <br /><" <br />4- <br /><u <br />Item / Location ......... .......TemperatureItem/Location <br />°F <br />Other:Quat. Amm.:Exp. Date:°F°F ppm <br />Phone: <br />Time Out:/? <br />EHD 16-24 (2nd pg) 4/3/13 <br />Name: <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 />\Co~ f yA^\ <br />Name of Facility: <br />Address: <br />Received By / Title: <br />EH Specialist: ’ <br />Time in: <br />Warewashing Sink: <br />Facility Hot Water Temperature <br />Hand Sink: op <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />---- <br />VO <L <br />Iuj I <br />>/us^ge —1 H <br />) v-—-* 4' <br />Owner/Operator: <br />Program Element: /615 <br />SB180 Posted Yes No <br />nJ <br />Warewashing <br />Chlorine: ppm Heat: <br />Food Program Official Inspection Report_______ <br />^l//h Date: < 2017 <br />po &QK zfeityx re <br />Food Safety Certification <br /> Temperature <br />Program Record: <br />Permit Posted Yes <br />. Date: <br />Zip Code: <br />Telephone: <br />ft-c 5^9 32, ^5 lnspection Type: r gv^gA/T <br />No Re-Inspection on or After: <br />--------1 it tA <br />Cjr> v ( <br />n Vv i \ Db^ pvi C />?<< t <br />— i 'P — <br />_i,, -s - A- ------- <br />\</r~ <br />? /6 Page |of/^ <br />FOOD PROGRAM OIR CONTINUATION <br />K-/S <br />i y <br />nto< xt-a. I