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\\Q <br />t <br />Name:PPm <br />ither:Quat. Amm.:Exp. Date:PPm <br />Phone: <br />Time Out: <br />\ rxyKZ T~ <br />\Oj-VK <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 />Item / Location <br />r i <br />Program Record: <br />Permit Posted <br />Warewashing <br />leat: <br />Page-zof <br />FOOD PROGRAM 0IR CONTINUATION <br />Temperature <br />F <br />Item/Location <br />\O <\J <br />\O <br />Chlorine:°F <br />No <br />Received By / Title: -------------- <br />EHSpecianst: \ <br />Timein^ \ \ <br />EHD 16-24 (2napg) 4/3/13 <br />°F°F <br />- 170 <br />Yes No <br />vAa_A-<^>Za. r? <br />O.z>? - C5 I <br />l^'lF <br />Temperature <br />HOF <br />__sap <br />o.\ p <br />Facility Hot Water Temperature <br />Hand Sink: op <br />Warewashing Sink: <br />2^ T CTF <br />2<A iMro^r, p M O) F <br />Z <br />eVFP' VP3 r f ZZ <br />2-cX CVp <br />VDkX^A>7. <br />2^ 'Fgzf <br />I V \ 3 ? ( _______ <br />(FZ7 F <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />~TD</cF iAF)t— <br />\Q rzz <br />Food Safety Certification <br />________ Food Program Official Inspection Report_______ <br />Name of Facility: yp OSC~/ /? Ir A-X £ C F/ Dale: I Q-I - <br />Address: ZZAc^XyZe Z yHa <br />Owner/Operator: _Z Telephone: <br />Program Element: Program Record: F Inspection Type: <br />SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: