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w: <br />Food Safety Certification <br />Name: <br />Exp. Date: <br />AW <br />Chlorine: <br />iQuat. Amm.: <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 />I <br />Facility Hot Water Temperature <br />Hand Sink: op <br />JWarewashing Sink: op <br />°F <br />°F <br />Address: <br />Owner/Operator: <br />Program Element: \ <br />SB180 Posted Yes No <br />Warewashing <br />•.,pm <br />ppm ||Other; <br />/W-WlAW (J) <br />4- "VVyg <br />'1 <br />city: <br />Food Program Official Inspection Report <br />WA.iWn-0 Ci,y:ivl Zipc°de:^ <br />Telephone: 3^ <br />InspeetlonType: ^ pp, , ) <br />Re-Inspection on or After: <br />_____ <br />(0) ofc <br />-------------------- I Tempera,, e <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />T)ClU^iwl dV- <br />Q|(V)_____________________________ <br />Name of Facility: ( VAVYlfc)off■ vm<AwY On _____ <br />' ■ Program Record: | £? <br />Permit Posted Yes No <br />Received By / Title: Y <br />EH Specialist: I \ \ t <br />Time inT JQY \ <br />EHD 16-24 (2"s pg) 4/3/13 <br />>hone: _ <br />T'^O^ ifcoOh_____^^l °l > <br />' FOOD PROGRAM 0IR CONTINUATION <br />CU - ioo_pp_ <br />_ i - <br />__Tp inrloos,___b-f, <br />U-iu? 4 (YA <br />& <br />r» PVAChv (X VcffiE <br />%• \ vyi i(DW <br />-W <br />CA-Wwrn <br />Oh(MLfcbanr) <br />• n <\ z-x f _ _ A <br />pA- ~