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w: <br />\7- <br />M ^2^7- 1^ <br />City:Zip Code: <br />Owner/Operator:Telephone: <br />Program Element:Program Record:Inspection Type: <br />SB180 Posted Yes No Permit Posted Re-Inspection on or After: <br />Pi <br />i cro- ioe>i <br />ml <br />kcVx <br />I <br />Name:Chlorine:°FPPm <br />Exp. Date:Warewashing Sink:Quat. Amm.:Other:PPm <br /> <br />Phone: <br />Time in:Time Out: <br />San Joaquin Cou <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 />\\^\\ <br />Name of Facility: <br />Address: <br />Warewashing <br />Heat: <br />Page-of <br />FOOD PROGRAM 0IR CONTINUATION <br />°F°F <br />Temperature <br />mi <br />Temperature <br />Hl r <br />{ <br />nsP <br />Item/LocatioY? <br />Cg <br />l mmscZ <br />Ifood Program Official Inspection Report <br />Dale: <br />Item / Location <br />xA-lj C V^-xds/sJ <k_£--x__________w..re., ...................... <br />Facility Hot Water Temperature <br />Hand Sink: op <br />SMo IH-I <br />Yes No <br />7^- <br />Received By / Title: \l *•! <br />EH Specialist: V~ <br />\i-Mm <br />EHD 16-24 (2nd pg) 4/3/13 <br />-Qr^ _ <br /><A \ \- <br />0 72 |\p <br />Ob <br />■X^£O0> <br />; ^>0, > <br />=.-----&— <br />\^Q>|- ~ cat <br />NoF <br />r <br />mm Ma2tc <br />bx> <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br /> <br />rXAO ^SyyxQ Qr~x Cr<\ <br />VKJO^/-VY~> Aq V~ <br />Su <br />/ ~V ~ ______ <br />Food Safety Certification