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City: <br />Telephone:Owner/Operator: <br />Program Element:Program Record: <br />Re-Inspection on or After:SB180 Posted Yes No Permit Posted Yes No <br />iZ <br />7 <br />fhrfc- <br />Temperature I TemperatureItem I Location <br />Food Safety Certification <br />hlorine:Name:Fppm <br />Other:Warewashing Sink:Exp. Date:Fppm <br />Received By / Title: <br />Phone:EH Specialist:, <br />Page ofTime Out:Time in: <br />FOOD PROGRAM OIR CONTINUATION <br />- <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 (2'«pg) 4/3/13 <br />Name of Facility: <br />Address: <br />Warewashing <br />Heat: <br />Item/Location <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />A/^uj^cs <br />_______________ <br />______Food Program Official Inspection Report <br />Date <br />—/ City: Zip Code: <br />0X0 <br />Facility Hot Water Temperature <br />Hand Sink: op <br />oF llQuat. Amm.: <br />rK - <br />//^r