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TemperatureItem / LocationItem/Location___ <br />Food Safety Certification <br />Name:°F <br />Quat. Amm.:Warewashing Sink:Exp. Date:°F°F ppm <br />Phone: <br />PageH'of *-|Time Out: <br />• • <br />Chlorine: <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.sjqov.org/ehd <br />= <br />Temperature <br />OOP <br />___^112 <br />Food Program Official Inspection Report <br />Date: <br />Zip Code: C^{ <br />Telephone: -----(J <br />. — <br />Facility Hot Water Temperature <br />Hand Sink: op <br />FOOD PROGRAM 0IR CONTINUATION <br />pt.i;ri t i’kt i U'uf/tikinspec,'°nTyp,;i/'pxliry Wr?P <br />Yes No * Re-Inspection on or After: ’ <br />Warewashing <br />~ ppm ||Heat: <br />Other: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />(^)4\d2in BL Ww <br />Ug^nvi i-ktz/ns- ~ <br />jo) ifc>e,a ki net <br />rripD pprr <br />Received By / <br />EH Specialist: S-J I <br />Mmom: (g-.D^rr? <br />EHD 16-24 (2“pg) 4/3/13 <br />Name of Facility: <br />Address: PgCWyC <br />Owner/Operator: Q <br />Program Element^Program Record: <br />SB180 Posted Yes No Permit Posted