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A <br />OvA-drxPr-Spf-v <br />\J'C\ <br /><A d < <br />\<C\ ; es (gL. <br />TemperatureTemperature <br />Food Safety Certification <br />°F <br />Name: <br />(Other:°FPpm°FExp. Date: <br />Phone: <br /><^\ - \q \ ~ Q <br />Item/Location <br />A OO^Q^I <br />Item / Location <br />Program Record: <br />Permit Posted <br />Aa \A__ <br />g_ <br />Orx\\^-Q_ ( <br />San Joaquin County <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 />\nJ \ <br />Chlorine: <br />Quat. Amm.: <br />UC' <br />t) <br />\ A <br />rv <br />Yes No <br />Facility Hot Water Temperature <br />land Sink: °F <br />i/arewashing Sink: <br />CW f <br />Page^ of <br />FOOD PROGRAM 0IR CONTINUATION <br />.VA <br />O V\cx^ <br />A-< <xd <br />op-^e d <br />& OfA\) \ dp <br />\ n Va p\, r f s_____ <br />S j Cj (A J . ( cj____ <br />'2Q<A-io^0-A02.5' <br />TlmeOutr^ . <br />Wckj ~v A g eno <br />c~ p (W/kXT <br />F~ cCxcAA \ \ o <br />v C a v~v~x ~0~OA r~\ <br />Vxc> €* ZYAO^L \e d3 <br />Warewashing <br />ppm |H^ <br />■=f'<~T C V'Jv AMYA__1 <br />b -Q- CfACvx A 3—:_ <br />~S Ok_A CM <br />V>Q O-Ajr- <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />A-Vve_ cV\smI vaScv (a) grcvCA ^-<svac\------------- <br />V\ cVvMiC-VxLA/ \ (g ^/WyC. I • <br />tx)eeb * <br />Vaeca I <br />Q <br />c?rw\ <br />Name of Facility: <br />Address: <S^ <br />Owner/Operator: <br />Program Element: ( \ <br />SB180 Posted Yes No <br />C^cxA^APTY <br />M__\ n-^pec <br />Mi H----P^M A- <br />Ubb,Jr <br />Received By /Title: \ J <br />EH specia,is^^^^^ZIMISZ^z^ <br />Time in: \ | ', \ 5 __________________ <br />EHD 16-24 (2nd pg) 4/3/13 <br />Food Program Official Inspection Report_____ <br />y g / cz VxcC Cliwj \ G-g_________Dale'_ <br />Zip Code: <br />Telephone: <br />Inspection Type:^ x S <br />Re-Inspection on or After: '