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r <br />OV<2 SActe <br />in WL <br />. tfeAQ^yOCh ficLp4.sti^_ot_V4^EikWitiou <br />ft uS;V to\2( r.i cX Kx(?y <br />Temperature |Item/Location Item / Location Temperature <br />Food Safety Certification <br />Name:F <br />Exp. Date:ither:°F Ppm <br />= <br />1 Phone: <br />EHD 16-24 (2^ pg; 4/3'13 FOOD PROGRAM OIR CONTINUATION <br />6/G2zj____________________________________________ <br />v are cypen. - <br />O\ea i <br />CcrTgC^cT <br />h> cgvc< <br />Received By / Title: <br />EH Specialist: <br />Time in: <br />Name of Facility: <br />Address: <br />Program Record: <br />Permit Posted <br />| Facility Hot Water Temperature <br />(Hand Sink: Op <br />'Warewashing Sink:°F <br />OjOOI - 4 <br />Time Out: Pag <br />Warewashing <br />ppm |Heat: <br />Owner/Operator: <br />Program Element: <br />SB180 Posted Yes <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />XClL^X/- <br />Chlorine: <br />Quat. Amm.: <br />San Joaquin Cou y <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 />(Ik) VAr. perp't, <br />-oF. <br />yugo - <br />” food Pi-ep <br />W <2ncK0S>v(ii <br />- PvWicbz q Tarp <br />Toad gr-efl - <br />'OF <br />yAgNg s ■ <br />VO IO0 -I091T, <br />- F-'Ce >s at' <br />-OF- <br />and <br />Food Program Official Inspection Report <br />Date: lb/'&/’(:?■ <br /><72-\ > , c<z<vw City: ZipCode: cxro2 <br />Comex'ixe ___________Telephone: <br />Program Record: V-0 ^^4 I 2- ^-4 Inspection Type: <br />No Permit Posted Yes No Re-Inspection on or After: