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Yes No Re-Inspection on or After: Permit Posted <br />Owner/Operator: <br />ciProgram Element: 3 <br />3 SB180 Posted Yes No <br />Address: <br />Name of Facility: <br />171? S. <br />tWPaktelidK14 I c 4cr, Date: /, s. j 5 <br />C y: 4 )e Zip Code: <br />Telephone: 7.2 3 _ js <br />Inspection Type: gi j . <br />7 1 eN, <br />V, r 7 ; PO I r <br />grogram Record: 5 3 6J3 <br />SAN JOAQUIN COUN <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazeiton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.orq/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />OBSERYATIONS"ANia,dORRE'cTivgActstiN <br />V; 010 <br />em / Location Temperature <br />r •11; 01 <br />i 5 <br /> Are ''es 'pet . <br />Food Safety Certification <br />Name: / Pa • / <br />Exp. Date: .7 <br />, <br />cility Hot Water Temperature <br />0 °F <br />arewashing <br />Hand Sink: Chlorine: PPm :Heat: `F <br />Warewashing Sink: °F Quat. Amm.: PPm Other: °F <br />ReceivedBy / Title: <br />EH Specialist: Phone: <br />Time Out: <br />441-J <br /> <br />Time in: <br /> <br />s Page of <br />/ <br />El-ID 16-24 (2^, pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION