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Clty: NA-Vx Wxxxze <br />No <br />a Q <br />\ I O<& <br />vpf?vrx <br />\\yo-1 0& v <br />£a. <br />\CTQ - I H <br />Item/Location <br />Food Safety Certification <br />Hand Sink:°FName:eF ppm <br />Other:Quat Amm.:Warewashing Sink:°F°F ppm <br />Phone: <br />EHD 16-24 (2* pg) 4W13 <br />s^y ces c m <br />Warewashing <br />Heat: <br />Exp. Date: <br />Received By / Titlei^^^4 <br />EH Specialis^^c^JJ^J^j <br />Time In: <br />Im)-yU <br />\3 ) VX rc\ "Soorx <br />V\jO Vp^'F'- <Ocx^rf\ A- <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />< C t Cso (j/2. <br />F <br />_ VA'\rA--Q <br />\i5Q~ <br />- <br />Temperature <br />M4-E- <br />Temperature <br />*2~7F^ <br />____ zLQCA — ^o\ _______ <br />TimeOut: Pag^jaf <br />FOOD PROGRAM OIR CONTINUATION <br />Ct X3 <br />X'ZJ) <br />rxeg^cA <br />i 11aS C— <br />IS5R <br />■AYxrz^ V P <br />AAQ kr^ezt>^A <br />yC) - <br />.Facility jtot Water Temperature <br />Chlorine: <br />Item/Location <br />A3?) ‘ e\\\ ez?_ Ckdr^.5 <br />_____ <br />iJK VAry^ <br />, Cfo 6^- <br />____________Food Program Official Inspection Report <br />Name of Facility: C y ~T Dale: " <br />Address: y VAxj^ ZlpC°de: <br />Owner/Operator: Telephone: <br />Program Element: \ Program Record: Inspection Type: <br />SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <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