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C F-rVl <br />City:Zip Code: <br />Telephone:Owner/Operator: <br />Inspection Type: <br />\eA.C<r.V~-< ~ O\< <br />C I^Xz'-v-a. Q >' OK CBM <br />-OK c FM <br /><aS <br />Temperature :Item/Location Item / Location Temperature <br />Food Safety Certification <br />Name:hlorine:Fppm <br />Warewashing Sink:Exp. Date:uat. Amm.:Other:ppm <br />Phone: <br />Time Out: <br />EHD 16-24 (2"°pg) 4/3'13 <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 />Name of Facility: <br />Address: <br />Warewashing <br />Heat: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br />Facility Hot Water Temperature <br />Hand Sink: ep <br />°F °F <br />j ■ i, <br />Received By / Title: <br />Program program Record; SQwm2&_______________ <br />SB180 Posted Yes No Permit Posted Yes No / Re-Inspection on or After: <br />_____Food Program Official Inspection Report <br />CL V /SZ- 2-^X5-^-^ ,'r^A A Date: <br />M. b & O __________ <br />PagVfb <br />FOOD PROGRAM 0IR CONTINUATION <br />EH Specialist: <br />Time in: < <br />F \J x A