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Address: <br />SB180 Posted <br />OB') <br /> Bl? <br />I <br />Temperature <br />Food Safety Certification <br /> <br />Name:°F <br />Warewashing Sink:Exp. Date:°F °Fppm <br />KeAds *Received By I Title: <br />Phone:EH Specialist: <br />Page of <br /> <br />Time Out:Time in: <br />EHD 16-24 (2«’pg) 4/3/13 <br />CT] <br /> <br /> MA <br />Chlorine: <br />op Quat. Amm.: <br />JZ- <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 />A <br />^7^ <br />—odt ko u-x <br />C’SZJ <br />Temperature <br />OBSERVATIONS and corrective actions <br /> ■ 4 /n cm . <br />ao°i- loBlo- <br />2/2f- 4/6 301'2 <br />//^ ?rAA/' <br />FOOD PROGRAM OIR CONTINUATION <br />2 -PviLPcl Am ice <br /> <br /> fl) <br />3 <br />>n^iCS * P <br />/kA? ^o-y) Zk^j> <br />Warewashing <br />ppm |lHeat=“ <br />Other: <br />Telephone: <br />inspection TyPoy^y/^ j -fZ <br />Re-Inspection on or After: ' <br />Facility Hot Water Temperature <br />Hand Sink: oF ( <br />/o,7 j <br />S />}- <br />Item/Location <br />_____________Food Program Official Inspection Report <br />Name of Facility: Date: 2 Z <br />ftddress: A/, Clty: z'pCode:B5-^3/. <br />Owner/Operator:- A <br />IProgram Element^ a / ; ^Program Record: <br />Yes No Permit Posted Yes No / J ' <br />n . 7>o <br />4>4_ < WJI^,- <br />Item / Location <br />-^-7-------------------------------‘ <br />v< c cr ._______________--------y <br />‘kkxX pTYTXcJ^ rr (A^CcL