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Zip Code: <br />Owner/Operator:Telephone: <br />Program Element: <br />SB180 Posted Permit Posted <br /> <br />all <br />t <br />4>-tvi7r>p,<.w <br />tuy^F <br />foul 4tv^f <br />Item / Location TemperatureItem/Location Temperature <br />Food Safety Certification <br />Chlorine:Name:FPPm <br />•thenWarewashing Sink:Quat. Amm.:Exp. Date:°FPPm <br />Received By / Title: <br />Phone: <br />c i <br />EH Specialist: <br />Time in: <br />San Joaquin Coi^r <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 />Name of Facility: <br />Address: <br />Warewashing <br />lHeat: <br />Page^of <br />FOOD PROGRAM 0IR CONTINUATION <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />Uu/ <br />°F <br />- <br />Facility Hot Water Temperature <br />Hand Sink: op <br />rWbo_ <br />\j\tj <br />Food Program Official Inspection Report <br /> Date: C <br />Yes No <br />th2^ ~ <br />(-&J <br />A-’’ / 1 <br />w:' Fimliii <br />Program Record: <br />Yes No <br />MvAwlk (f^__Tun __Poy <br />L? 2.-______ <br />- Wil J <br />- (?F <br />oV-fu0 , (/>VyJkA * <br />cw<. ' * * <br />('Cvw^Xzo ci,Y;<fecU* <br />t ‘ Ckw"*. <br />EHD 16-24 (2™ipg) 4/3113 T ' <br />Time°ut M’.g) <br />Inspection Type:^ A- <br />Re-Inspection on or After: ’