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City:Zip Code: <br />_______ <br />Telephone: <br />inspection Type:Program Element: <br />Re-Inspection on or After:SB180 Posted Yes Permit Posted Yes No <br />f <br />A’ <br />i 2 } <br />^7?__ <br />PPm <br />Exp. Date:Warewashing Sink:Quat. Amm.:Other:°F °FPPm <br />Received By / Title: <br />EH Specialist:Phone: <br />Time in:Time Out:Page of <br />EHD 16-24 (2"«pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />E <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 />■ <br />T - <br />shing <br />Heat: <br />Name of Facility: <br />Address: <br />Program Record: <br />No <br />____ <br />Chlorine: <br />Facility Hot Water Temperature <br />Hand Sink: op <br />A <br />°F <br />Food Program Official Inspection Report <br />Date: <br />____ <br />Name: <br />Food Safety Certification <br />V <br />. Z- <br />Owner/Operator: