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(Y> Q y <br />City: <br />1 <br />Cj'- A,qE <br />l/<ArsV>2( <br />k <br />( . <br />\ C ) <br /><’i <br />:hlorine:Name:F <br />ither:luat. Amm.:Warewashing Sink:Exp. Date:F ppm <br />^eU'oSSp <br />Phone: <br />EHD 16-24 (2"“pg) 4/3/13 <br />Received By / Title: <br />EH Specialist: <br />Time in: <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 />Program Record: <br />Permit Posted <br />Temperature || <br />"A <br />FHD ? a <br />[ <br />Temperature <br />^4 I F <br />"F <br />xAi <br />5 <br />Yes No <br />Warewashing <br />ppm <br />Food Program Official Inspection Report________ <br />■T— ** Corzx AAenT-e. Date: VO- '3.24 <br />> i City: Zip Code: <br />Telephone: <br />Inspection Type: <br />Re-Inspection on or After: <br />Item / Location <br />d-d Aq/xA <br />Facility Hot Water Temperature <br />Hand Sink: =p <br />19>\ F <br />2A pg , <br />-Trx^Q, - F <br />2-<a PpJa-- ~T c\^? -mr <br />m2, p <br />F ty-V-Ar^ - <br />Name of Facility: (Y\ ' <br />Address: . <br />Owner/Operator: <br />Program Element: y IrjjA <br />SB180 Posted Yes No <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />\-MTTAdd7s r;< <br />••• <br />F-.o,.-* <br />Item/Location <br />(JgRFxS ~V ■ A. p'l 22^ pr-<Y? <br />Food Safety Certification <br />v( c - -Gni vl ch <br />ri i -1 <br />v Jmk-A—Q-Rv_________ <br />. QfeP - 3^ <br />7^ \j <br />- lol b- 3>O25~ <br />TimeOut: Page-£>f <br />FOOD PROGRAM 0IR CONTINUATION