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w: <br />No <br />-V <br />Temperature Item / LocationItem/Locatlon <br />Food Safety Certification <br />Phone:EH Specialist: <br />lime in: <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 />c',y:illf,Ut ilziin <br />Name: <br />Exp. Date: <br />ppm <br />ppm <br />J___ <br />Chlorine: <br />Quat. Amm.: <br />Warewashing <br />leat: <br />)ther: <br />°F <br />°F <br />Yes No <br />Facility Hot Water Temperature <br />land Sink: op <br />i/arewashing Sink: oF <br />J Temperature <br />EHD 16-24 (2"d pg) 4/3/13 <br />Food Program Official Inspection Report________ <br />Li/AtH mz) m/tin „ Date: <br />WT iWlin <br />hr.rr.m....... z,, ' <br />Program Record: 'pInspection Type: ~ <br />Permit Posted Yes No Re-Inspection on or After: <br />Name of Facility: <br />Address: I^F <br />Owner/Operator: <br />Program Element: <br />SB180 Posted Yes <br />Time Out: () Pa9e I of 2, <br />food program oir continuation <br />g) C4aA€V 21X CMvHS <br />(y SanbqA C(\j2c--KS <br />100pm <br />ir\oov --------- <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />(JOHm <br />--------------- <br />■ <br />V0 0 jin <br />---------------------------------------------------------------------- <br />I <41 <br />iVtA-sc -*- At V - <br />g) C* G< SwWg>- —