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t <br />4 <br />w <br />Temperature <br />Food Safety Certification <br />Phone: <br />-Time Out: <br />FOOD PROGRAM OIR CONTINUATIONEHD 16-24 (2nd pg) 4/3/13 <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 />_ <br />COo&L'T * 1 <br />Item/Location <br />Name: <br />Exp. Date: <br />Chlorine: <br />Quat. Amm.: <br />Warewashing <br />Heat: <br />Other: <br />PPm <br />PPm <br />Name of Facility: <br />Address: <br />Owner/Operator: <br />Program Element: <br />SB180 Posted <br />Received By / Title: <br />EH Specialist: <br />Time in: <br />°F <br />°F <br />-yxz' p S Ki __ <br />sHpS Noi rm 5<2, <br />vs (f~~_/ J' J . > . j r * yu. <br />Facility Hot Water Temperature <br />Hand Sink: «p <br />Warewashing Sink: oF <br />4 >7 f- A iL ri i- i <br />0 il <br />(oc^Y-^— | o <br />^ 2 (7(ViAAi'n/r <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />/.ZZ 6M/ ”---------7- <br />- .____ ______,__z <br />{< ( O ; ' v / I 1 <br />, 1 <br />Ifl P <br />Temperature <br />_______ __________ — <br />I'Zl/K(^) Blac|Z <br />----------0o <br />Clty: <br />—^5-------n <br />___. <br />-----52— <br />H 4t9 doA . <br />pYZrWX -jrlcwjU , <br />( Jfi nd" <br />__"3 S > ( <br />,?^F__________ <br />(M Hl / ' <br />Item / Location <br />.^/■Z'Z— <br />Food Program Official Inspection Report <br />3^4- /j A K-v X ciiy; . zipc^ 33z_ \ ' L^ ' Telephone: <br />V2 'n,peCtl°nT,p,: <br />Yes No Permit Posted Yes No ' 1 / Re-Inspection on or After: / <br />JSIL fefzL ■l±s 1ISL I <br />C 1r> S ) H K. <br />---------------- <br />) cJ-J- f y <br />YJ ? 'Ast V OA* <br />JO (t> F r>d~ ftyk