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,V'|A <br />■^r. C>/y <br />S <br />✓H, c^A “/yu? <br />Food Safety Certification <br />22Sm Phone: <br />. n\2C <br />^7A - <br />Heat: <br />Other: <br />T^ <br />fnQKi' <br />vn <br />Name: <br />Exp. Date: <br />Chlorine: <br />Quat. Amm.: <br />°F <br />°F <br />kffj- f" -s' <br />Q/1 o / ^b7I <br />dz/Sers I <br />6 r F <br />?i!?j <br />5 _s-y&^vfo <;> ./JvFf fesF <br />Z*)'p / <br />Program Record: <br />Permit Posted Yes <br />___________ <br />hv>i— <br />cfwel rl [I T'tJ d- <br />FF^; ‘^‘Z---30 F----------- <br />/<? i v , i & q-tz <br />a /dx^f27 n__F___ _____ ____ <br />n't JL/lr./nC F ) ’/'{ed <br />LT^y^. — /pgr F rfjrJtedj. ^Js- <br />y -y Jy i.u- L~ <-- <br />’£2 /> clerfc^jg _ 1 <br />■y Fze_ /qSf -vF /ozo^2> jjM-r <br />__^1 £> PHF F l SS1F <br />ak*v<-- nwf't »- <br />/\J^ ^'rW <br />wd, f FrxUj e^) (-^Tf <br />: Temperatve <br />(i_ . _____ <br />rj b c)(^aj^^ PJ^ cF) <br />(po Fj <br />-3 <br />4-e4U^v <br />(Fu^=^— <br />■ / a> /’i d<2. c~ * * <br />f2> —Pz r v Az; rL OTZ; u <br />£ 13sV'& c dl PnX <br />Item / Location | Temperatjjre <br />.ttML A/ <tr< Zezy <br />''-2^ <br />Warewashing <br />PPm <br />PPm <br />Time Out: ,_^ vf" Page of <br />————1—---------------------i— <br />FOOD PROGRAM OIR CONTINUATION <br />. * <br />_ ’----------e----------'------------— ■ /- >----------U-4T <br />AJz? j Nh Pa\ <br />pir^ > <br />"1' i <br /><90 F / <br />... JpcFk c^r\ : <br />'1 <br />_Fr&> v t *£A cIgSu —>■__• <br />~ Al_dc^._Co'/d ,_A/ <br />O-nA1pfe-t0.^z4^.^<xA2 <br />2^ _^i—P^r^ Azi' ■'TL./ w -v <br />^u^44/Z fct ^>x? <br />—RcF A? k_4 <br />&L-F FAaF-AS.-Izl_ asUkc^: <br />P, F l-Kko«-r?. <br />------P V—“ C ‘_ ______icL-lvEL <br />rW, [db) /zgjZz/zd <br />, K F^--1’^ drfTTUp ^r<iV^ <br />p, . Item/Location I I Temperature . <br />'Z^'ci ^^PV'^.v'^^T... <6HF^ zkjzZ^. <br />'tM IO 2'^a'vi . ® <4- rFQ i ft F/ j l <br />i; Facility Hot Water Temperature <br />Hand Sink: op <br />Warewashing Sink: op <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />c 4c1^-4 f ZhZ F <br />; FJ^ hen. / <br />San Joaquin Cou / <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (20^) 468-3420 Fax:j(209) 464-0138 Web: www.siqov.orq/ehd <br />Zy 4z2^YfX^G'-F^ ' <br />Food Program Official Inspect40n Report <br />....z' F - - 'i P\. PateT" <br />• S Ai/FF- City: --Ui-h) ZipCode: <br />Is Telephone: <br />?2 L \ | Inspection Type: <br />No Re-Inspection on or After: * <br />Received By / Title: /S5 <br />EHS^i, <br />TiTOte IDy'j^ ' <br />EHD 16-24 (2nd pg) 4/3/13 <br />l^grxt <br />',*2=7-, <br />\/J faring <br />Name of Facility: <br />Address: <br />Owner/Operator: <br />Program Element: <br />SB180 Posted Yes