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City: <br />3 OOHA p <br />(j . . <br />^<50 <br />Temperature i Item I LocationItem/Location <br />Food Safety Certification <br />°FPPm <br />Other:F°F PPm <br />A) <br />Page of <br />FOOD PROGRAM OIR CONTINUATIONEHD 16-24 (2nd pg) 4/3/13 <br />Name: <br />Exp. Date: <br />Chlorine: <br />Quat. Amm.: <br />Received By / Title: <br />EH Specialist: <br />Time in: <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 />Owner/Operator: <br />Program Element: <br />SB180 Posted Yes No <br />Warewashing <br />Heat: <br />Ok" C I <br />| Temperature <br />Facility Hot Water Temperature <br />Hand Sink: <>F <br />Warewashing Sink: <br />'_______ <br />CA a cd (' <br />- <br />refr' i^Qrci’ <br />S '7 3 2^ . <br />/ ' . /, i K) ____________________ <br />Program Record: 5‘7 <br />Permit Posted Yes No <br />Food Program Official Inspection Report <br />Name of Facility: Nlc|^MttrKe4-_______________________________________________Date- 3'7-2^ <br />Address: -i-7'Z _ <_ n \ City: 1 1 / Zip Code: <7$'2(S- <br />Telephone: <br />Inspection Type: <br />Re-Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />rl OJ -- 1'7.^ -IocpJiotV <br />-V |<_e_ - |AO 1 f <br />by u /rvvxc^— 3 • <br />3 . I fr, »OV& "• 3Ge*Mp--- (V ’ ______ <br />Phone: QG~3o7o <br />Time Out: <br />5/^re<L <br />0/ V<Qrs - <br />rroP -up <br />[4 . <br />- s Kee 4 -(-o ■ <br />(o . A 3 c-<::>AzVf7 <br />kv\ KetZcLPci (rc><^ 14 AaJ . <br />4U_^ C_A“V<- <br />~7 • V l Cvq (aS/' o — 3> P -— <br />»(a '/Iajl. Gok\4-c<( Fver'-X <br />‘do P * <br />CAf" _ —' ?c>^ zio'F cloi^c^j^A i C<z--c-k^s4s