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City: <br />Re-Inspection on or After:SB180 Posted <br />2 <br />c <br />\ \ I <br />= <br />A <br />Chlorine:Name:PPm <br />Warewashing Sink:Quat. Amm.:Exp. Date:°F°F PPm <br />Phone: <br />Time in: <br />EHD 16-24 (2nd pg) 4/3/13 <br />33 u <br />3 <br />San Joaquin Coun i y <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 />Inspection T<pe^ <7 <br />ction on or After: <br />Received By / Title: <br />EHSpecialieA>wI^ <br />I c.^ <br />Temperature <br />FOOD PROGRAM OIR CONTINUATION <br />S3 | 03^- <br />No <br />~ iSSi- <br />Pagej of <br />{2s <br />- <br />Item/Location <br />(\<r — <br />\ <31 <br />Time Out: 'tvW <br />Temperature | <br />Z^r <br />38 p <br />H ir <br />Food safely Certification^; ; ||C Faciiity Hot Water Temperature <br />Hand Sink: op <br />Food Program Official Inspection Report_______ <br />Date: 1 ^7 - ) ) °] <br />Zip Code: A <br />Telephone:C|ay . Qc?o „6- <br />Prograrrt1 Record: <br />Permit Posted Yes <br />________ <br />Name of Facility: x - <br />Address: <br />Owner/Operator: \ y 1 'O^'S <br />Program Element: y <br />Yes No <br />IVZ <br />"-qZ cLoy ~ A-A i i <br />tV-n-JojT- cj <br />2 _______ <br />___________ <br />$ <br />■. -stehasJ'v