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i Srt WwW-ffl <br />Re-lnspi <br />Food Safety Certification <br />Name:ppm <br />:her:Quat. Amm.:Exp. Date:°F PPm <br />Phone: <br />z? /v, — ip <br />EHD 16-24 (2™ pg) 4/3/13 <br />A 7 » <br />I___ <br />Chlorine: <br />Received By / Titlef <br />EH Specialist: <br />Time in: <br />°F <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.org/ehd <br />~r^x) c y <br />Name of Facility: <br />Address: <br />Warewashing <br />leat: <br />City: <br />Temperature Item / Location T <br />. ______________________________________________ <br />.oc/-5bl <br />Facility Hot Water Temperature <br />Hand Sink: »p <br />Warewashing Sink: <br />°F <br />-7 :7S Z?/H— niYI <br />'.r’ j) ( h' <br />------------ <br />z-7 <br />Time Out: <br />Owner/Operator: <br />Program Element: <br />SB180 Posted Yes <br />-S' / / <br />/DO <br />~r~ <br />•— r/o^/r’/tL <br />/ S X • <br />7 <br />X <br />run'1 Lt2 <br />Page/of Z r O' <br />FOOD PROGRAM 0IR CONTINUATION <br />T R.A <Ly < CUT I I Rfi P^4 r k <br />I/ //F - <br />/ o <br />7. <br />------------------77 <br />// / /ri ■ / ° 67 <br />(Q lybfryyU^^ <br />Ice <br />n tO<- ^07 hO- <br />u iff /i i/i_ #7 Cyc! t <br />ui^jer-' ! y Cf-C c. vt-j'-Sf <br />1 yy'’''' - <br />Item/Location <br />z) <br />/6?vr/uZ.?ogramRecord: FF\03 <br />5 No / Permit Posted Yes No <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />Cy9 /_____________ _______________ <br />6vvx A' ^7 \ y V—*_____ 5 ’ <br />t <br />J C I A L, <br />__A/ Q____/O <br />ch/nX <br />Hz* U D C)/n /<^ <br />Food Program Official Inspection Report_______ <br />Dale: £>//■■//2,5 <br />Zip Code: * V <br />Telephone: <br />Inspection Type:^ f <br />Re-Inspection on or After: <br />\,' ! VX-f ■ ~ o <br />- - , z <br />_AfeCV-^\v,oY <br />’ /o O <br />iG/k)CC<-\ <br />C- fi -r > <br />vi - <br />/ o <br />op' rti-e D/ft