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r> <br />Zip Code: <br />Program Element:Program Record: <br />SB180 Posted Permit Posted Yes <br />Item/Location Temperatuie Item I Location Temperature <br />Food Safety Certification <br />Name:Chlorine:PPm <br />Exp. Date:Warewashing Sink:Quat. Amm.:Other:°F 'FPPm <br />EH Specialist:Phone: <br />Time in:Time Out:Page <br />Z<-7, "V-X <br />FOOD PROGRAM OIR CONTINUATION <br />San Joaquin Cou^f <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 />Name of Facility: <br />Address: <br />Warewashing <br />Heat: <br />C'ty: <br />°F <br />L4 <br />Owner/Operator:Telephone: <br />Inspection TypeT^ Xa<-^L <br />Re-lnspection on or After: 7 <br />Food Program Official Inspeqtion Report <br />Yes No No <br />h <br />Facility Hot Water Temperature <br />Hand Sink: op <br />Received By / Title: <br />/(? <br />EHD 16-24 (2nd pg) 4/3/13 <br />cl <x J , <br />7 <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />. JI AJL r Azrlc