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I <br />City: <br />Owner/Operator:Telephone: <br />Program Element: <br />SB180 Posted Permit Posted <br />o <br />6 CU\ <br />i hLiw <br />- aU <br />U/lA/ I 2--T^ <br />Vs ; <br />r [ts/aaamhv <br />Item/Location Item / Location <br />;_:\7 w <br />Name:Chlorine:FPPm <br />Exp. Date:Warewashing Sink:Quat. Amm.:■ther:°F °FPPm <br />Received By/Title: <br />EH Specialist:Phone: <br />Time in: <br />yvx <br />San Joaquin CoU^y <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 />a a <br />4Yin/^~ <br />Name of Facility: <br />Address: <br />Warewashing <br />leaf: <br />m v <br />Page| of <br />FOOD PROGRAM OIR CONTINUATION <br />Temperature <br />Food Program Official Inspection Report <br />Pate: C/ts/l^ <br />Zip Code: <br />(e^ - <br />l/> a (zt’hcvA'____ <br />( l’v.v-'IA <br />j/ <br />Eg Q/ <br />■-fr k-IAz <br />H. <br />£ V ____t^c^yvx <br />M, t VA Cvufo Srfc^yv' cc<A^ <br />Food Safety Certification <br />700- <br />Time Out: u <br />EHD 16-24 (2nd pg) 4/3/13 ' <br />Saw <br />Yes No <br />M # XbvYwwA <br />Ly ) <br />-0^1 <br />Inspection Type:^ ^ ,y <br />Re-Inspection on or After: <br />( J <br />0s <br />Yes No <br />-- m rr <br />Wt,<W - vzvi^Vyvvi^______ <br />Temperature <br />____’-X'_______ <br /> tzJb <br />Facility Hot Water Temperature <br />Hand Sink: Op <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />Vv=- \(7S <br />--------M— <br />__uv.il <br />•.Vf.-U m ,-A <br />WW-j <br />Program Record: <br />\ ZholoX <br />- XglX <br />—,- -W- <br /><X >» A-