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City: <br />Telephone: <br />Inspection Type: <br />Re-Inspection on or After: <br />^2 <br />f*vm <br />Temperature TemperatureItem / LocationItem/Location <br />Food Safety Certification <br />Chlorine:Name:ppm <br />Other:Quat. Amm.:Warewashing Sink:Exp. Date:F PPm <br />Received By/Title: <br />Phone:EH Specialist:,^ <br />Time Out:Time in: <br />FOOD PROGRAM OIR CONTINUATION <br />4^ <br />Name of Facility: <br />Address: <br />Warewashing <br />Heat:°F <br />°F <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />Facility Hot Water Temperature <br />Hand Sink: op <br />llz£> y JC IM<y <br />Owner/Operator: |/<| ’ <br />Program Element: ^Program Record: <br />SB180 Posted Yes No Permit Posted Yes No <br />------------------------------------------------------------ <br />San Joaquin Col / <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.orq/ehd <br />EHD 16-24 (2* pg) 4/3/13 <br />Food Program Official Inspection Report <br />Date: ^//?//,9 <br />1 L Oi ' zip Code: