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I <br />Item/Location <br />Food Safety Certification <br />°F <br />Phone: <br />Temperature <br />Name: <br />Exp. Date: <br />Chlorine: <br />Quat. Amm.: <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/ehci <br />°F <br />Name of Facility: <br />Address: <br />Owner/OperStor: <br />Program Element: <br />SB180 Posted <br />°F <br />Telephone:^ <br />Facility Hot Water Temperature <br />Hand Sink: <br />Warewashing Sink: <br /> OBSERVATIONS AND-CORRECTIVE ACTIONS <br /> ■ EnMH) VC VHl'HCA- C O cfonoi <br />_________________________________1_________________________________________«__-____-______________________ <br />' Temperature <br />in <br />i wri'lwii i url <br />& Mvu9) I Liw.WTbTp- <br /> jwnwtf1 wi\vyv .SrmkaAj <br />Warewashing <br />ppm <br />ppm Pther7 <br />Q Wl WIWV <br />boo HOvt] <br />Yes No <br />~T~ <br />Time Out: TVA Pag^lof <br />' FOOD PROGRAM 0IR CONTINUATION <br />Inspection Typef^? ^/]4~ <br />Re-Inspection on or After: <br />ci,y\3Wfe)k) <br />«: rklii LQ£«k:< <br />Received By / Titlez^ <br />EH Specialist: tA <br />Time in: I 1 ' A <br />EHD 16-24 (2"°pg) 4/3/13 <br />burn \XlirAri <br />Program Record: <br />Yes No Permit Posted <br />-tp itprea <br />c,L- ice pp pi_ tCs-(|Ti)P <br />(n) ftw nxLKjr . z <br />tferlkH H CHfcppB <br />j to off i drry vwiorrP <br />Item / Location’ <br />Food Program Official Inspection Report <br />NKihT~ c, .y, ' Datex[rj7l^■n-r.-i2- to Clly: tWKto kJ Zip Code:, W