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OBSERVATIONS AND CORRECTIVE ACTIONS <br />( <br />Sv / <br />I I <br />Item / Location <br />Heat:Name: <br />Quat. Amm.:'arewashing Sink:Exp. Date:F PPm <br />I, <br />Phone: <br />Time Out:Time in: <br />Program Record: <br />Permit Posted <br />Temperature <br />\CV2 V' <br />V5s?ST~ <br />No <br />■ <br />San Joaquin Coun i y <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 />Temperature <br />M IF <br />--Chlorine: <br />\ f <br />Received By/Title: 1/ <br />EH Specialist: i <br />\\'sS <br />EHD 16-24 (2"° pg) 4/3/13 <br />CgTy-rSrVT <br />'Oippn'_'QjSs_ <br />2<-a>w? iSSF-f <br />°F <br />I 5 j tby Vo j -, ?< 'V<, ?<g)S\ sso <br />Food Safety Certification <br />°F <br />Yes No <br />_______s,O \ <br />Owner/Operator: <br />Program Element: <br />SB180 Posted Yes <br />i F <br />\A CSo-9^ \ -'vof <br />2a osn - m \ r <br />C ___ <br />\d-& <br />7 b- <br />Page—pf <br />FOOD PROGRAM 0IR CONTINUATION <br />"1 <br />\d <br />__________2-d, <br />Facility Hot Water Temperature <br />land Sink: <>F <br />_____________Food Program Official Inspection Report <br />Name of Facility: 'POO-XPleC/A 4 C.CV^ lOH- <br />[Address: . /C\ pyb-YFe ' City: Zip Code: <br />Telephone: <br />Inspection Type: <br />Re-Inspection on or After: <br />PPm <br />Other: