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Address: <br />Owner/Operator: <br />r <br />TemperatureItem / LocationTemperatureItem/Locatlon <br />Food Safety Certification <br />Name:°F <br />tther:'arewashing Sink:Exp. Date:°F°F ppm <br />Received By / Title: <br />Phone:EH Specialistr <br />Page, of.Time Out:Time in: <br />FOOD PROGRAM OIR CONTINUATION <br />San Joaquin Coun <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 />Chlorine: <br />Quat. Amm.: ________ <br />Program Element: <br />SB180 Posted <br />Warewashing <br />ppm |Hea* <br />EHD 16-24 (2nd pg) 4/3/13 <br />“ c ‘1 ' ■ *___CL<c>-4-P e-e - <br />mx. . <br />kvr kyruLcV-; c-v4-< <br />Facility Hot Water Temperature <br />Hand Sink: op <br />- S-ell, <br />____ <br />-fr^/Q A o r ex <br />p <A <br />315^ <br />Yes No <br />Name of Facility: | Z|. ,;( <br />3 03 A i -Cy c, ncTr i c < <br />g-Fr-en \/i i|€i r^xi <br />Program Record: <br />Yes No Permit Posted <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />( ITO <br />_Iol <br />ex p <br />a O\)rL\ <br />S <br />Food Program Official Inspection Report______ <br />g< T 6^0} rs e’________Date. g <br />Pl __________City: ZipCode: ga2-Q9 <br />__________TelePhone: ^,2-0)2 <br />Inspection Type: <br />Re-Inspection on or After: <br />Lf on ) <br />nA <br />k? <br />i/g AHn H-Ka S