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A. <br />City:Zip Code:________ <br />Owner/Operator:Telephone: <br />Inspection Type:Program Element:Program Record: <br />SB180 Posted No Re-Inspection on or After:Yes No Permit Posted Yes <br />- <br />; k <br />7 <br />I <br />I <br />f7 <br />—rA <br />■ <br />TemperatureItem/Location Item I Location <br />Food Safety Certification <br />Name:°Fppm <br />Exp. Date:Warewashing Sink:Quat. Amm.::her:F °Fppm <br />EH Specialist:Phone: <br />Time in:Time Out:Page of <br />EHD 16-24 (2"°pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />HJ. <br />____ <br />r <br />_____ <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.sjqov.org/ehd <br />h/ <br />c / <br />___L <br />i i <br />4— <br />Received By / Title: <br />Name of Facility: <br />Address: <br />Warewashing <br />leat: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />< <br />_________ <br />Food Program Official Inspection Report <br />Date: <br />_ <br />Facility Hot Water Temperature"^! <br />Hand Sink: op Chlorine: <br />PA <br />I ' /---------- <br />- I -j J <br />— <br />—- <br />) 11