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) <br />Item / LocationItem/Location <br />Food Safety Certification <br />EHD 16-24 (2nd pg) 4/3/13 <br />FiiW <br />Name: <br />Exp. Date: <br />Page |of<^. <br />^OOD PROGRAM OIR CONTINUATION <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 />EH Specialist: <br />Time in: <br />ihlorine: <br />iuat. Amm.: <br />Warewashing <br />Heat: <br />Other: <br />PPm <br />ppm <br />°F <br />°F <br />am <br />Name of Facility: <br />Address: (_J|/jZ-y) <br />Owner/Operator: j' <br />Program Element: <br />SB180 Posted Yes <br />7 <br />Facility Hot Water Temperature <br />Hand Sink: op <br />Warewashing Sink: <br />^Foej^' <br />Pbon.: <br />TimeOut: A <br />'Pi<Zh - on (CCrh: s/vr irrv . <br />(g/rw <br />VAv <br />Item/Location Temperature Item / Location TemPe <br />______________OBSERVATIONS AND CORRECTIVE ACTIONS <br />foStYina- hili '.kwii rhpos^- ~[>m^ ,tpe lAwUbte no sampling.. ----------- <br />ffikrcyA po^vyse. v ___ <br />ViO--?5^7 <br />Food Program Official inspection Report , <br />yi ^nzvAVllh CeWiT-^XhZ/'S I'jlauifef" DaB: 7/I'A W/rtiryMiP ^snrrti-fv zlpCoae: <br />ctesâ–  Te|eph°ne- <br />Program Record: tQ^spection Type: . <br />No Permit Posted Yes No Re-Inspection on or After: