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No <br />Item / Location TemperatureItem/Location <br />Food Safety Certification <br />Chlorine:Name:°Fppm <br />Other:luat. Amm.:Warewashing Sink:Exp. Date:°F°F ppm <br />Phone: <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.siqov.orq/ehd <br />Warewashing <br />Heat: <br />Pagej°fc| <br />FOOD PROGRAM 0IR CONTINUATION <br />Facility Hot Water Temperature <br />Hand Sink: <br />Name of Facility: <br />Address: | <br />Owner/Operator: (A <br />Program Element^W" <br />SB180 Posted Yes <br />_____________ OBSERVATIONS AND CORRECTIVE ACTIONS <br />(fe) Dvffiuvo /o+m <br />jj) etmfrTMn vawiAij wiarfi - onli t, no ^.<ainpliix) <br />B l\ly i 'V/UhTS - ixce <br />(R) t UnO ij t/T.gni c, - pypctUGe <br />fouws - piiduc^1 <br />g) lg/<, TfuzTnuA- - <br />(WPSln - pnxtuGA- <br />yvWT W*7 ijuzW — <br />Pi Tain p -ppgiyffi- <br />Item/Location ’ Temperature <br />Time Out: <br />iw: n <br />Food Program Official Inspection Report <br />JoflAtur) Date:^J^P^City:rViTrZipCode:6/<7R <br />_ Telephone:-^. <br />Program Record: -t PR|j|7 6 Inspection Type:p^^|j^ y ) <br />Permit Posted Yes No Re-Inspection on or After: * <br />Received By / Titler^^^~ <br />EHSp.ei.ll.., I i Vtl (A 7lt YP <br />Time in: <br />EHD 16-24 (2nd pg) 4/3/13