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4. <br />Re-Inspection on or After: <br />e r H t <br />P Ir^ <br />H <br />J Temperature= <br />Food Safety Certification <br />Ta <br />EHD 16-24 (2nd pg) 4/3/13 <br />Received By / <br />EH Specialist: ' <br />Time in: <br />Phone: <br />Time Out: <br />Chlorine: <br />Quat. Amm.: <br />Heat: <br />Other: <br />Warewashing <br />PPm <br />ppm <br />_> <br />_______ <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 />V- I CA <br />------- <br />°F <br />°F <br />Name: <br />Exp. Date: <br />> Date: <br />Zip Code: <br />Telephone: <br />jWcxrF <br />---------------- <br />Temperature <br />M 75 <br />No <br />Facility Hot Water Temperature <br />Hand Sink: <br />Warewashing Sink: op <br />Sr - 1 <br />o to -g-i <br />U4 <br />bo Ferenc <br /><2. O Vt----------- <br />< Too CD <br />* <br />Item / Location <br />Name of Facility: <br />Address: <br />Owner/Operator: <br />Program Element: <br />SB180 Posted Yes <br />Program Record: <br />Permit Posted Yes <br />p— <br />r <br />U> ftS_________ <br />>________\ Of? <br />xP'ip i /U ______b ■-^A' <br />o fc vC f <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />S <br />______Pag^.°' <br />FOOD PROGRAM OIR CONTINUATION <br />y Q p <br />Food Program Official Inspection Report <br />>?-/fSz’jo /4 Zh <br />x ^42 7 S' z- t <br />/>A3^75 'n‘p*‘,l°"fizeA-A' <br />No Re-Inspection on or After: ' <br />wfcp-Pn/) <br />----------------- --- <br /><-■ WAWCVjJj a