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City:Zip Code: <br />Telephone:Owner/Operator: <br />Inspection Type:Program Element:Program Record: <br />Re-Inspection on or After:SB180 Posted Yes No Permit Posted <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />< <br />0^04 £ <br />U'Y <br />r* <br />< <br />I TemperatureItem / LocationTemperatureItem/Location <br />Food Safety Certification <br />Name:°FPPm <br />Other:Quat. Amm.:Warewashing Sink:Exp. Date:FPPm <br />Received By / Title: <br />Phone: <br />Pa.5 Time Out: <br />FOOD PROGRAM OIR CONTINUATION <br />EH Specialist: <br />Time in: <br />Name of Facility: <br />Address: <br />Warewashing <br />Heat: <br />J__ <br />Chlorine: <br />EHD 16-24 f?* pg) 4/3/13 <br />°F <br />Facility Hot Water Temperature <br />Hand Sink: op <br />Yes No <br />Food Program Official Inspection Report <br />Date: <br />________________ <br />San Joaquin Col v <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