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Zip Code:f\ <br />Telephone: <br />Program Record: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />(8 <br />\ r <br />j Temperature <br />Is <br />Food Safety Certification <br />Name:PPm <br />ither:Warewashing Sink:Exp. Date:F°F PPm <br />Phone:2-0^- <o I <br />Time Out: <br />EHD 16-24 (2nd pg) 4/3/13 <br />______ <br />Chlorine: <br />Received By / Title: <br />EH Specialist^-U- <br />Time in: \ i <br />_____- /V>\Zc4- _ <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 />CAob_ <br />Quat. Amm.: <br />3Z <br />m i uwA (6 <br /><5- <br />mk <br />A Ar <br />Item/Location <br />Warewashing <br />Heat: <br />Pag§—^f <br />FOOD PROGRAM 0IR CONTINUATION <br />Name of Facility: <br />Address: \ <br />Owner/Operator: <br />Permit Posted Yes No <br />Temperature <br />°F <br />City: <br />Food Program Official Inspection Report______ <br />Date: <br />Facility Hot Water Temperature <br />Hand Sink: op <br />Ge r V <br />~ -Gob pp Q \ <br />AG <br />Item I Location <br />Inspection Type: y-q <br />Re-Inspection on or After: <br />Program Element: \ A <br />SB180 Posted Yes No