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Zip Code:City: <br />Telephone: <br />Inspection Type:Program Element: <br />Permit PostedSB180 Posted <br />TemperatureItem / Location <br />Food Safety Certification <br />Chlorine:Name:°F <br />Other:Quat. Amm.:Warewashing Sink:Exp. Date:°F°F PPm <br />4 <br />Received By/Title: <br />EH Specialist: <br />Time Out:Time in: <br />EHD 16-24 (2nd pg) 4/3/13 <br />3^S' <br />1 PH______ <br />/ l^L <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 />ft/. 'V'i. ( 4' / <br />( Z)S- . <br />rsvr S> <br />A <br />Name of Facility: <br />Address: <br />Facility Hot Water Temperature <br />Hand Sink: -p <br />Item/Location <br />Warewashing <br />ppm peS? <br />' Phone: <br />^-1 f <br />rvA <br /> - —'C^ • <br />M J f t -4 <br />Noi 7 Re-Inspection on or After: <br />’’■'’V' 4/ <br />FOOD PROGRAM 0IR CONTINUATION <br />1 AAi <br />/ (3-i <br />ii 1 <br />• 102^-\0^ <br />c Jl C ^1/ 7 D <br />4--Im: rkdui Ljlufc :< <br />Yes No <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />D _________ <br />__________' k? Z$<£- <br />_____Food Program Official Inspection Report <br />/ Zz -0 /4f //>» ZkiH. pa*e' L2- <br /><7 City: z'pCode:V?3aZ <br />Owner/Operator: --77,^ 73 X<4? /Z/V- <br />Program Record: <br />Yes <br />CXzf/l$ I kl€^------—?-------------------- ---------- <br />f A. A 4^ ^^-yc7~ A Amo-i <br />X 7^7 ( i*- -i . <br />'felcltiJ’ xqLo/fed1'