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City: <br />QI 4 <br />vQ/ <br />OfirV^-r-^ <br />9- <br />\M ) N\ <br />)J <br />Item I Location | Temperature <br />Food Safety Certification <br />°F <br />Phone: <br />•fTime Out:i <br />EHD 16-24 (2"°pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />FtWFfrl <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 />Name: <br />Exp. Date: <br />Received By / Title: <br />EH Specialist: <br />Time in: <br />Warev <br />PPm <br />PPm <br />ng <br />Heat: <br />Other: <br />°F <br />°F <br />Temperature <br />f ; C <br />I<sQx-Q$4? <br />Item/Location <br />\ OJ T CQ C Y 2 I) <br />Chlorine: <br />Quat. Amm.: <br />Facility Hot Water Temperature <br />land Sink: op <br />i/arewashing Sink: <br />(r\ -T^VyY^ <br />Address: <br />Owner/Operator: <br />Program Element:.. <br />SB180 Posted Yes <br />______ <br />A. v v > <br />■ OBSERVATIONS AND CORRECTIVE ACTIONS <br />TYo 1I5P Cc^s-Q 4o <br />____________ Food Program Official Inspection Report________ <br />Name of Facility: Date: ~7~ 1^2,1 <br />(V\cu,pJlQ Av€- 1 Clty: ZlpCode: <br />V Telephone: <br />Awaz/ iW-^ara'T1Rec°,d: / •SM^34 lni,|^nTyiw:P<xrlV<2/TF <br />No ' Permit Posted Yes No ' Re-Inspection on or After: ' <br />__________________CfTM