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Zip Code:City: <br />Telephone:Owner/Operator: <br />Inspection Type: <br />Re-Inspection on or After:SB180 Posted <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />(B A A c <br />/ZVQ/NJo <br />)PAqj? - Cc \ <br />sc?) <br />TemperatureItem / LocationTemperature <br />Food Safety Certification <br />Name:TPPm <br />Other:Quat. Amm.:Warewashing Sink:Exp. Date:F°F PPm <br />Received By / Title: <br />Phone: <br />Time in: <br />EHD 16-24 (2™>pg) 4/3/13 <br />San Joaquin CountW <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 />Warewashing <br />Heat: <br />CCVa. <br />ncy> r <br />—TT'- <br />Pag<YH <br />FOOD PROGRAM OIR CONTINUATION <br />v loo Pf\rAAj(_o <br />Facility Hot Water Temperature <br />' Hand Sink: op Chlorine: <br />______________Food Program Official Inspection Report______ <br />Name of Facility: f CFAA. 4 °ate: M - 2_ k I 8 <br />Address: <br />EH Specialist <br />V'oOTTS / <br />Yes No ' <br />1 <br />Program Element- , ^Program Record: <br />Yes No Permit Posted <br />Time Out: