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Zip Code:City: <br />Telephone:Owner/Operator: <br />Program Element:Inspection Type:Program Record: <br />Re-Inspection on or After:SB180 Posted Yes No Permit Posted <br />C <br />TemperatureItem/Location Item I Location Temperature <br />Food Safety Certification <br />Name:FPPm <br />Exp. Date:'arewashing Sink:Quat. Amm.:ither:°F °FPPm <br />Received By / Title: <br />EH Specialist:Phone: <br />30Time in:Time Out: <br />EHD 16-24 (Z^pg) 4/3/13 <br />A. S'! y&L <br />San Joaquin Couni . <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 />Name of Facility: <br />Address: <br />Warewashing <br />jHeat: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />FOOD PROGRAM OIR CONTINUATION <br />Food Program Official Inspection Report <br />Date: /< <br />______ <br />Chlorine: <br />r -1,~ <br />Facility Hot Water Temperature <br />Hand Sink: op <br />Yes No <br />_________________^^4____ <br />—IS- <br />/Z S’