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£ <br />Date: <br />City:Zip Code: <br />Owner/Operator:Telephone: <br />Inspection Type: <br />SB180 Posted Re-Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />IPC <br />I <br />4$, <br />Item/Location Temperature Item / Location Temperature <br />Food Safety Certification <br />Name:Chlorine:Fppm <br />Exp. Date:Warewashing Sink:Quat. Amm.:Other:F °FPPm <br />Received By / Title: <br />Phone: <br />Time Out: <br />EHD 16-24 (2"°pg) 4/3/13 <br />EH Specialist: <br />Time in: / <br />Name of Facility: <br />Address: <br />Warewashing <br />Heat: <br />Food Program Official Inspection Report <br />Pagtf^bf <br />FOOD PROGRAM OIR CONTINUATION <br />Program Element: // Q <br />Ydf No <br />Soa'P VJL&A 4^ <br />- - • A SAi*. <br />Facility Hot Water Temperature <br />Hand Sink: op <br />Program Record: <br />Permit Posted Yes No <br /><4rcU <br />(Awxaq y--~ ‘ <br />evil - <br />_____ <br />San Joaquin Col i <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 />• i vOy- |