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Zip Code:City: <br />Telephone: <br />7Inspection Type: <br />Re-Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />4Z <br />toIiv <br />£ <br />Item / LocationItem/Location <br />Food Safety Certification <br />Chlorine:Name:F <br />Quat. Amm.:Warewashing Sink:Exp. Date:°FPPm <br />A <br />Phone: <br />Pa.ofTime Out: <br />FOOD PROGRAM OIR CONTINUATIONEHD 16-24 (2«pg) 4/3/13 <br />Name of Facility: <br />Address: <br />Warewashing <br />Heat: <br />Temperature <br />°F <br />Food Program Official Inspection Report <br />Dale; &//3 Trf <br />Program Record: <br />Permit Posted Yes No <br />Owner/Operator: <br />Program Element: <br />SB180 Posted Yes No <br />—-4=U=— <br />pf-r-iipr <br />Temperature <br />San Joaquin Cou ! <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjqov.org/ehd <br />Facility Hot Water Temperature <br />Hand Sink: °F PPm <br />Other: