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4^] <br />City:Zip Code: <br />Owner/Operator:Telephone: <br />SB180 Posted <br />CF/M <br />T <br />A. <br />) <br />) <br />Temperature I TemperatureItem I LocationItem/Location <br />Food Safety Certification <br />Name:hlorine:Fppm <br />Exp. Date:Warewashing Sink:luat. Amm.:ither:F °FPPm <br />Received By / Title: <br />Phone: <br />Time in:Time Out:Pageuj>f <br />FOOD PROGRAM OIR CONTINUATION <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 of Facility: <br />Address: <br />Facility Hot Water Temperature <br />Hand Sink: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />Warewashing <br />(Heat:F|C <br />a <br />j i _________ <br />C Y\O sx) <br />Program Element: program Record: M <3 3 H <br />Yes No Permit Posted Yes No ' ReJnspection on or After: <br />Food Program Official Inspection Report <br />Date: <br />C\ Axr-^ <br />_AprAcksA •______!___ ____ <br />____________________________________v \ F - \ \ C \ CXkS__________________ <br />___________________Cn \ v <br />________________________yA (\j\ \ Aox A____________ <br />_______________________________________ ________________________________________ <br />___________________ ______ _____Lx ’-S ____________ <br />(VA <br />inspection Type: Tf- <br />qA a xrX <br />7 <br />EH Specialist: \ ) <br />EHD 16-24 (Z-opg) 4/3/13 <br />rvAoj i ~Vos <br />\<AAcL^rx "V Grill