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Owner/Operator: <br />- cn< - (ec <br />CK <br />recM <br />'fl <br />7 <br />O. O. o\ \ <br />7> <br />Chlorine:*FName:ppm <br />Other:Ouat. Amm.:Warewashing Sink:°FExp. Date:°F ppm <br />Time In: <br />EHD 16-24 (2* pg) 4/3H3 <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 />Program Element: <br />SB180 Posted <br />Warewashing <br />Heat: <br />I MZF <br />Received By / Tit|^: M1 <br />EH Specialist: \ ) <br />\op-10 <br />rflge ^Qi <br />FOOD PROGRAM 0IR CONTINUATION <br />IQiV I o& R <br />/CgK - c <br />____ ______________Item / Location <br />M <br />M I <br />H <br />Item/Locatiori <br />\ <0 <br />Food Safety Certification <br />Temperature <br />I F- <br />3SP. <br />F <br />Temperature <br />mar <br />Facility Hot Water Temperature <br />Hand Sink: op <br />Name of Facility: <br />Address; <br />■SM^TZS, inspection Type: goc)-V; <br />Re-Inspection on or After: <br />Food Program Official Inspection Report <br />x/tMtA/vka* Date: ^■‘5 2^ <br />Zip Code: sSSC| <br />Telephone: <br />Yes No Permit Posted <br />f\eeAp <br />KrO \23- ec <br />Q__S <br />_Lf -04.-, __________ <br />< Phone: 2. ■ Ip | O?-V <br />“^= Time Out: Page -of <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />’ ' • * t7« <br />c^> FC <br />______________________________ <br />Clty: <br />Program Record: . <br />Yes No <br />V LJ? <br />f^(><<GCsr\~Vc* <aC\v~x - r-OOr-A <br />i <br />iGc\Ao~ in°i <br />~ pp <O