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Zip Code: <br />Re-Inspection on or After:Permit PostedSB180 Posted <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />5 <br />Cl- <br />cr <br />TemperatureItem / Location <br />Food Safety Certification <br />Chlorine:Name:ppm <br />Other:Quat. Amm.:Warewashing Sink:Exp. Date:FPPm <br />Phone: <br />Received By/Title: <br />EH Specialist: <br />time in: <br />San Joaquin Coun\ <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 />|-(u.wv <br />Page| of <br />FOOD PROGRAM 0IR CONTINUATION <br />Temperature <br />Warewashing <br />Heat: <br />EHD 16-24 (2«pg) 4/3/13 <br />Name of Facility: < <br />Address: C,As^y <br />Owner/Operator? ^.4 <br />°F <br />°F <br />____Ho -tvf <br />Program Element: ' <br />Yes No <br />-UuJ— <br />HuJ <br />_____ V{^ 109 ^ <br />Facility Hot Water Temperature <br />Hand Sink: op <br />Item/Location <br />f?// F // P___ <br />Telephone#/^^74 <br />Inspection Type: X~Program Rdfcord: / <br />Yes No <br />Food Program Official Inspection Report <br />■- ■ '■ /e