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City: <br />ex <br />Telephone: <br />SB180 Posted <br />9 <br />Rpr? H - <br />o, <br />1 <br />6Item /Location TemperatureQO <br />Food Safety Certification 4 <br />Hand Sink:°FName:°F <br />Quat. Amm.:Warewashing Sink:FExp. Date:°F <br />Received By/Title: <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.org/ehd <br />Co <br />__ 2O°i- Vo 1 b - ^>025 <br />Time Out: Page^f <br />FOOD PROGRAM 0IR CONTINUATION <br />Temperature <br />IflkF <br />_ <br />Chlorine: <br />-s H V, Z3 "1spectl°n Type: / 7^ ■ <br />Re-Inspection on or After: <br />* ? OBSERVATIONS AND CORRECTIVE ACTIONS <br />Program Record: <4 ”7 o / <br />Yes No ' <br />■almj <br />EH Specianst-^,^^ C <br />Time in: <br />Warewashing <br />ppm p* <br />ppm <br />Program Element:>bqs <br />Yes No Permit Posted <br />' Item/Location <br />-fisVx <br />Name of Facility: y <br />Address: i \ —i-’C zx. a______\ \ <br />Owner/Operator: <br />( . V\)TSCp <br />1^5- <br />Food Program Official Inspection Report <br />Oate: <br />Zip Code: <br />J3 ) .jtCA ZCr^r-P<><>-n <br />•^ecn^? -V