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Zip Code:City: <br />Telephone:Owner/Operator: <br />Inspection Type:Program Record:Program Element: <br />Re-Inspection on or After:NoPermit Posted YesSB180 Posted Yes No <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />=2 i <br />3 <br />c< <br />Temperature ||Item / LocationItem/Location <br />Food Safety Certification <br />hlorine:FName:ppm <br />Other:luat. Amm.:Warewashing Sink:Exp. Date:°F ppm <br />Phone:EH Specialist: <br />Page ofTime Out:Time in: <br />FOOD PROGRAM OIR CONTINUATIONEHD 16-24 (2™1 pg) 4/3/13 <br />Received By/Title: <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.sjqov.org/ehd <br />Temperature <br />________ <br />3 c <br />Name of Facility: <br />Address: <br />Warewashing <br />Heat:’ <br />°F <br />2^ c<c<p S pc^l ___________ <br />25, <br />Food Program Official Inspection Report <br />Facility Hot Water Temperature <br />Hand Sink: op <br />~~ ^K.<x4g. —__ <br />k.L3. __________________________ <br />I <, Cx\j -_______ _____________________ <br />c, 4- Af-ecXec/___ ____ <br />a cL Ua c<S /a---4-q 8 y ________________ <br />o-/ — (XO U < Ga Cf-Le^ <br />5____________ <br />tyvio . 5 <AtA.— /n-ee 3 c>^v2. <br />G-hlo^ik^- Q P