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City: <br />Yes No' <br />p/\y#LoCt <br />JC_A(e <br />5 <br />TemperatureItem/Location Temperature <br />Name:°FPPm <br />Other:Quat. Amm.:Warewashing Sink:Exp. Date:°FPPm <br />Phone: <br />EHD 16-24 (2nd pg) 4/3/13 <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 />Item / Location <br />;A <br />:V,sV\ <br />( <br />Warewashing <br />Heat: <br />Received By / Title: <br />EH Specialist; <br />Time in:Pag^of q <br />FOOD PROGRAM 0IR CONTINUATION <br />°F <br />______ <br />Chlorine: <br />S>Vux krr-^ ~ \ A <br />(ssrv <br />- s <br />VbO \QSr-~ <br />3 ? <br />__a \ <br />ArV*4 <br />Hand Sink: <br />' baol C\.A <br />Food Safety <br />Owner/Operator: <br />Program Element q, o / \ t_q <-Program Record: <br />SB180 Posted Yes No Permit Posted <br />TimeOut: —' 2_ <br />Uft 0>i~__________ <br />yfftp________ <br />11II I«^n II i LLIII <br />Facility Hot Water Temperature <br />F <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />~~ 7^ <SYx s«A< <br />\io . ___________________________ <br />t C-3n e-Px/*\z- C^-.P-Q <br />py^r~\) cC-g <br />rV^.V. • <br />A ’A <br />_____________Food Program Official Inspection Report_______ <br />Nameof Facility: CfOSS CRM 'r T b <br />Address: City: Zip Code: <br />Telephone: <br />mspectlon I <br />Re-Inspection on or After: '