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City: <br />£l <br />1^0 S'ko^L? <br />(jp <br />TemperatureItem / Location <br />Food Safety Certification •itf <br />Name:°F <br />Exp. Date:°F°F <br />Phone: <br />EHD 16-24 (2nd pg) 4/3/13 <br />ra <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 />T <br />s <br />b <br />4^ <br />Received By / Title: <br />EH Specialist: <br />Time in: <br />Program Record: <br />Permit Posted <br />Facility Hot Water Temperature <br />Hand Sink: oF <br />Warewashing Sink: <br />Chlorine: <br />Quat. Aim: <br />Date: <br />Zip Code: <br />Telephone: <br />Inspection Type: <br />Re-Inspection on or After: <br />Warewashing <br />Heat: <br />Other: <br />ppm <br />ppm <br />Yes No <br />Name of Facility: <br />Address: <br />Owner/Operator: <br />Program Element: J <br />SB180 Posted Yes No <br />Page of <br />FOOD PROGRAM 0IR CONTINUATION <br />i J/lA L j Ct cf <br />A JA (Z fvt Cl I f<£ /A- <br />r —j? ~ Fix'O n jkl / <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />----------< I <br />(jjt)-------------frosty ■ <br />Food Program Official Inspection Report <br />Lj z? iA (X-_________ <br />j^S TMikd" <br />|~~ rrv\ Fee <br />Item/Location <br />Time Out: , <br />(Q? F/l <br />4 /W T <br />r7 5 (aJ___________________ <br />FcS —------------~n------ <br />If F ~ io <br />( M CM B \___ _ ___ <br />’A?<s’ » K’