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£■ <br />Telephone:Owner/Operator: <br />Program Element: <br />SB180 Posted Permit Posted <br />Z <br />7- <br />er 'Jir it <br />7^ <br />&*>1 i'^ t' <br />&.•«v <br />4/p Ji«g^pZe s <br />TemperatureItem I LocationItem/Location Temperature <br />Food Safety Certification <br />Chlorine:Name:°Fppm <br />Quat. Amm.:ither:Warewashing Sink:Exp. Date:°F °FPPm <br />EH Specialist: <br />Time in: <br />r _____ <br />San Joaquin Count . <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 />EHD 16-24 (?«pg) 4/3/13 <br />Name of Facility: <br />Address: <br />Warewashing <br />Heat: <br />Page/of /■ <br />FOOD PROGRAM OIR CONTINUATION <br />^7 ft/*- jpAc - <br />Facility Hot Water Temperature <br />Hand Sink: op <br />Clty <br />Inspection Type: <br />Re-Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />Meow - /W <br />Received By I Title: <br />X---------------------------—----------■------------------------------------------------------------ <br />ChArtlrtr' Otwierce., <br />Program Record: & 9 2- <br />Yes No <br />■■ rn. .'^\ <br />rv„L|i <br />TimeOut: ,/q <br />Food Program Official Inspection Report <br />2>^ Date: /^//?A9 <br />A'lfi'in ci ct'l i'Ve^l^.y S^- City Zip Code. <br />JL><^ <br />Yes No