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■/ ly? <br />Zip Code:City: <br />q f\ <br />Telephone:Owner/Operator: <br />Program Element: <br />SB180 Posted <br />Sail <br />-l-p <br />;a <br />ra )1 Or <br />^Lf <br />Tree i O-C C^O <br />TemperatureItem / LocationTemperatureilem/Location <br />Food Safety Certification <br />Name:Chlorine °Fppm <br />Other:Quat. Amm.:Exp. Date:°F°F PPm <br />Phone: <br />Time Out:Time in:) <br />Warewashing <br />Heat: <br />Facility Hot Water Temperature | <br />Hand Sink: op <br />San Joaquin Coun <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 />/"I Ou ru- <br />Name of Facility: <br />Address: <br />Page of <br />FOOD PROGRAM OIR CONTINUATION <br />[lb k J <br />Sol <br />ir\___- <br />Jo&c.y <br />Inspection Type: ■y' <br />Re-Inspection on or After: <br />I SC <br />Cofrrc! Lcefc'/ <br />Clfci <br />Ser <br />5^ <br />U n , Z <br />on <br />Ixty <br />Poll '°$S6__________ <br />Program Record: S'S / 0 <br /> Yes I <br />s <br />/6 ^5 <br /> Yes Hermit Posted <br />O igira^ ( <br />0/ | f <br />___ <br />i r\ <br />£q^4/'/lom A u rfpr: <br />(T) C/yr\cJ'- Wler\ /- <br />: <br />Reef z^oor <br />-Qu) <br />MJ <br />S^r(-__ <br />(p Pos -I <br />£ J <br />CrockpeJ' I SA ______ <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />6KT^e'iVJf/> I'cfopr. Wf, pol-Jcr/sf/ <br />Co \ r> k- Self SCr^e._________________ <br />D^pi^y^rr 2 door- <br />_' n.____9___Apr/)6_Kiichen— <br />dis p la y <br />b]p <br />f) - U 7 f SI.'door ' <br />\/ i Olcth onS ________ <br />Warewashing Sink: <br />Received By / Title: <br />|EH Specialist: <br />EHD 16-24 (2nd pg) 4/3/13 <br />Food Program Official Inspection Report <br />Date: /g-^67-/4 <br />IS^ <br />___C a p S_ <br />\ c- day <br />ClOSeJ <br />dre