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Yes No <br />I'lJo <br />Le <br />o <br />cY <br />4- c <br />TemperatureItem I Location <br />Food Safety Certification <br />Chlorine:Name:ppm <br />Other:Quat Amm.:Warewashing Sink:•FExp. Date:°F ppm <br />Phone: <br />EHD 16-24 (2* pg) 4/3*13 <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 />Warewashing <br />Heat: <br />V \ V <br />IO <br />•F <br />Telephone: <br />Inspection Type: <br />Re-Inspection on or After: <br />Facility Hot Water Teniperature <br />Hand Sink: <br />/±1 <br />Name of Facility: y <br />Address: <br />Owner/Operator: <br />Program Element^ <br />SB180 Posted Yes <br />Ako'S2/ <br />No Permit Posted <br />r> Item/Location(z. <br />Food Program Official Inspection Report______ <br />AUvk o^A- - Date: J • 2<v <br />City: Zip Code: <br />> tiW—P — * <br />%po.O <br />CW~X <br />- J - OBSERVATIONS AND CORRECTIVE ACTIONS <br />•5, X^V\^Q_ V^St-g, £T-e^ ’S.Zy C <br />A-fy CKoaA-oJ-- f eZ'ct-^ <br />Received By / Title: <br />Time In: <br />Q-Oq-blb- 302^ <br />Time Out: Pags-yrf <br />FOOD PROGRAM OIR CONTINUATION