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City: <br />Telephone:Owner/Operator: <br />■_Inspection Type: <br />Re-Inspection on or After:SB180 Posted <br />t <br />TemperatureItem / LocationTemperatureItem/Location <br />Food Safety Certification <br />Chlorine:Name:PPm <br />Other:Quat. Amm.:Warewashing Sink:Exp. Date:°F°F PPm <br />Received By / Title: <br />Phone:EH Specialist: <br />Page^ofTime Out:Time in: <br />FOOD PROGRAM OIR CONTINUATIONEHD 16-24 (2nd pg) 4/3/13 <br />San Joaquin Cou^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 />r~\C^ <br />i Go <br />Name of Facility: <br />Address: <br />Warewashing <br />Heat: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />1/ <br />Co <br />aS <br />Food Program Official Inspection Report <br />~ Dale: 6>//sJ/Q <br />Zip Code: <br />°F <br />J <br />ius <br />- <br />Program Record: <br />Permit Posted Yes No <br />Program Element: /z <br />Y(/s No <br />Z> <br />Facility Hot Water Temperature <br />Hand Sink: op <br />VVK.HI <br />( F.