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(21 <br />City: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />TemperatureItem / LocationTemperatureItem/Location <br />Food Safety Certification <br />0 <br />Warewashing <br />Heat: <br />Other: <br />PPm <br />PPm <br />°F <br />°F <br />PR <br />No <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 />Name: <br />Exp. Date: <br />hlorine: <br />luat. Amm.: <br />Page/of <br />FOOD PROGRAM 0IR CONTINUATION <br />Ocwmvivn______ <br />Program Record: <br />Permit Posted Yes <br />Phone: <br />T.m.Oot <br />^=^=^=^==J==^^= <br />Facility Hot Water Temperature <br />Hand Sink: <br />Warewashing Sink: »F <br />Received By / Title: <br />EH Specialist: / . <br />T'm,ln: 7 <30 zrrn <br />EHD 16-24 (2"“ pg) 4/3/13 ' <br />(uAMte ctm ~ <br />13.) 212211'1 ■ <br />do PRn^/OSP p. <br />daZpl (2b£22223£2L/ Door ________ <br />Dl.s<1 ' D1..:. ■ 1 r- _________________ <br />1-04 IC-fM rlDP, Dl/FD-fegm <br />411122 47/g-- 2113121D OeD <br />2^2227/ Q^i <br />____________Food Program Official Inspection Report_______ <br />Name of Facility: z . /I(1P Li2!ht2 <br />AddreSS: / 12,1. / .:______________________ ' _____________Zip Code: Cj <br />Owner/Operator: ________________________________________Telephone:^ / <br />Program Element: j 7f Program Record: pR J OPInspection Type: <br />SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br />A-fh i/a