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£ <br />b <br />Item / LocationItem/Locatlon <br />Food Safety Certification <br />Name: <br />Quat. Amm.:Exp. Date:F ppm <br />Phone: <br />Time Out: <br />EHD 16-24 (2nd pg) 4/3/13 <br />°F <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^4- <br />Th______ <br />Name of Facility: <br />Address: <br />Received By / Title: <br />EH Specialist: <br />Time in: <br />Warewashing <br />Heat: <br />_______ <br />Chlorine: <br />°F <br />| TemperatureI Temperature <br />Facility Hot Water Temperature <br />land Sink: op <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />Food Program Official Inspection Report________ <br />_ Pate' ' <br />A/ b/^1 A. J. r ~ . City: <br />Owner/Operato^y^^^^ TelePhone- <br />Program Element- j^^y ^ lnspectlon Type: <br />SB180 Posted Yes No/ J Permit Posted Yes No ' / 'Re-Inspection on or After: / <br />- 3^_C2______ <br />- Pa3e'o,2_ <br />FOOD PROGRAM 0IR CONTINUATION <br />PPcPlj bl3 <br />Yes No / Re-1 . <br />EWarewashing Sink: <br />Ow, LU _ PvJ ch ~ <br />'‘i'l ------------- <br />z 7: to Pm _______ <br />k >7 I A <br />—-—CLO <br />f^tA.pvi f'l'i-K's (f e^L-i__r__--------------------------------------------- <br />-------------r ----y---- <br />c<o ptsPoy <br />(z? ____________________________________________________________________________ <br />I__Pr i) t/lP f <br />ZCJ-y? miff's t Z<</ Ql <br />IAJ(// put -------------- <br />----------Sr/ ----------CLW^------- <br />_____JvT<rrtt. c s Vn n S A/ *? ( ^V-tetz (( 5 R 0^1^/ 5 Vyi ^L£ <br />PPm <br />Other: