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Zip Code: <br />Telephone: <br />Permit Posted <br />v—O <br />\ i oft r <br />k_±i <br />^cr^pJ2Ar^J) <br />x¥yrJ <br />\ 03 - I OS -H <br />( <br />z\ 4 <br />map <br />Chlorine:°Fppm <br />ither:'arewashlng Sink:°Fppm <br />Phone: <br />£ <br />ime in: <br />\~O <Ji S <br />v. tX) U <br />03 v~ •" <br />~Q\ Zo <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.orq/ehd <br />__ SSI- £Z33 <br />•\Z\KkOV <br />Facility Hot Water Temperatui <br />Hand Sink: <br />Warewashing <br />lHeat: <br />Sa " <br />- <br />Item/Location <br />" co <br />Temperature <br />v. <br />' * Temperature <br />- Sbr <br />Name of Facility: <br />Address: <br />Owner/Operator: <br />2.00-O\ 3-3025 <br />Time Out: Page-^f <br />FOOD PROGRAM OIR CONTINUATION <br />, O c Vo <br />Qg->rr—p <br />V rOQM cOg V^Ozxa -X <br />^2 <br />Food Program Official Inspection Report_______ <br />CA IcA ~~ 124 Date: (n~ I "I - Z.3 <br />\<yK O/" Ci y: <br />c <br />iture Item/Location <br />r7 r 33) (Sa 'V' <br />°F <br />op Quat. Amm.: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />1 <br />Program Eleme^-^^J ( 5 Program Record: \o~1~lc\/ k) Inspection Type: j ""T' <br />SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br />— <br />(Name: <br />fExp Date: <br />iReceived By / Title: — <br />|eH Specialist:— <br />EHD 16-24 (2nd pg) 4/3/13