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w: ri <br />NV- <br />Telephone: <br />Inspection Type:| T <br />SB180 Posted <br />J <br /> J <br /> <br />IE <br /> 1 <br />CA <br /> <br /> Q <br /> £ <br />( <br />1c <br />Temperature <br /> <br />Item / LocationTemperatureItem/Location <br />Food Safety Certification <br />Chlorine:Name:PPm <br />Quat. Amm.:Exp. Date:FPPm <br />Phone: <br /> <br />Time Out:Time in: <br />(N'V’b...) <br />Other: <br />Name of Facility: <br />Address: <br />Warewashing <br />Heat: <br />Owner/Operator: <br />°F <br />°F <br />Facility Hot Water Temperature <br />Hand Sink: °p <br />y \ -Q- <br />Or <br /> <br />P(2. Sm I foOV) <br />I'SSb'V u-s <br />Permit Posted <br />Program Element: . . <br />Yes Ni <br />Mlo<a~033o <br />'o’ 30 <br />VV <br />___IWla- Pie Oc/XtSO-rt- <br /><Aas <br />San Joaquin Co ty <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 />i Warewashlng Sink: <br />w\ <br />V <br />Food Program Official Inspection Report_____ <br />t A - ,t- x ,_________ Dale: fl-ZT-lft <br />City: \ . n/o Zip Code: q| 3~ 33^ <br />Program Record: <br />Yes No ' Re-Inspection on or After: <br />Page of <br />FOOD PROGRAM 0IR CONTINUATION <br />________z <br />Received By / Title: <br />EH Specialist: <br />S~’.?)Q> <br />EHD 16-24 (2nd pg) 4/3/13 <br />OBSERVATIONS AND CORRECTIVE ACTIONS