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Date: <br />City:Zip Code: <br />Telephone: <br />Program Element: <br />SB180 Posted Yes No Permit Posted <br />n,•i /1 i <br />Temperature TemperatureItem/Location Item / Location <br />Food Safety Certification <br />Name:Heat:Fppm <br />Exp. Date:Warewashing Sink:Other:°F °FPPm <br />Received By / Title: <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 />San Joaquin County <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 />z <br />■7. <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />----------------------------- --------------- --------------------------- <br />Chlorine: <br />Quat. Amm.: <br />Name of Facility: <br />Address: <br />Inspection Type: <br />Re-Inspection on or After: <br />— <br />___ <br />_____ <br />£ <br />Facility Hot Water Temperature <br />Hand Sink: op <br />_____________ <br />n P___ <br />— <br />■ t |l< • - l <br />__________ <br />—V/-?) L <br />Owner/Operator: <br />Program Record: <br />- <br />vu- >■ <br />______________ <br />A Ci <br />: ' L/ <br />ixMy /nik -- / H If <br />______/___________________________ <br />CmL 7 <br />Food Program Official Inspection Report <br />pCr// '/t <br />-j-'C 1-"/ <br />/ O x • z/, <br />S 7 <br />Yes No <br />________ <T1 _____________________________ <br />JM.__________ <br />Oct C^A'f: i.VI