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t <br />TemperatureItem / Location <br />Food Safety Certification <br />:hlorine:Name:°Fppm <br />Other:luat. Amm.:Warewashing Sink:Exp. Date:°F°F ppm <br />P? AJfe'C Phone: <br />Time Out: <br />— <br />San Joaquin County <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 />Received By/Title: <br />EH Specialist: <br />Time in: <br />Warewashing <br />Heat: <br />Page^of <br />FOOD PROGRAM 0IR CONTINUATION <br />Yes No <br />__L_ <br />Facility Hot Water Temperature <br />Hand Sink: op <br />Owner/Operator: <br />Program Element: | C[^) <br />SB180 Posted Yes No <br />Date: <br />Zip Code: <br />Telephone: <br />Inspection Type: jp p ■ <br />Re-Inspection on or After: <br />Food Program Official Inspection Report <br />Name of Facility: Lllh f V 'S | 2S <br />[Address: UfJ f\) ZiPCode: <br />Program Record: <br />Permit Posted <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />(^mrfflk^TEK -tEy-tDgP ~ <br />(^) Sn\i's W /, <br />(VAurrw£ 0 A umtj <br />______ <br />e, W <br />EHD 16-24 (2nd pg)'4/3/13 <br />Is <br />(?) w.i4hm\j -Pi^- (Tv in?? <br />| y-\<V,.{.Sl A f? - HI HA <br />Item/Location Temperature