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City: <br />NoNo <br />o <br />C r/MLOX\a(\ <br />r/M <br /><"?C <br />J <br />Y~\gecA <br />- ( e.c ' ck <br />Temperature <br />Name:Chlorine:F <br />Other:Quat Amm.:Warewashing Sink:°FExp. Date:°F ppm <br />Phone: <br />Time Out: <br />C\ <br />EHD 16-24 (2* pg) 4W13 <br />T <br />E <br />I <br />C i <br />o *n <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 />Name of Facility: <br />Address: <br />Received By / Title: <br />EH Specialist^ \ <br />Time In: /Qi <br />- ka t b- 3O2A <br />FOOD PROGRAM 0IR CONTINUATION <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />Item/Location <br />v y- <br />- < ec 'cA______________ <br />• rec’dl <br />Facility Hot Water Temperature <br />Hand Sink: op <br />sZGi——t <br />----------- <br />Warewashing '' J <br />ppm <br />Food Program Official Inspection Report_____ <br />__________________Date: <br />Zip Code: <br />Telephone: <br />Inspection Type: <br />Re-Inspection on or After: <br />Owner/Operator: <br />Program Element: <br />SB180 Posted Yes <br />Program Record: <br />Permit Posted Yes <br />/eG‘d__________ <br />re c ______________ <br />XErM- ~ Aec(d <br />c <br />Temperature Item / Location <br />^>\rc'\c\ <br />\Ak) rr^cc^vA-^ <br />\ <br />' Food Safety Certification <br />ScybeA^zO <br />, -- re<r 'A_________ <br />\-^Qk7\r<