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City: <br />' •OBSERVATIONS AND CORRECTIVE ACTIONS <br />( <br />m fc <br />A <br />dxsp C k2J) <br />Heat:Chlorine:Name:°FPPm <br />Warewashing Sink:Quat. Amm.:ither:Exp. Date:°F°F PPm <br />Phone: <br />Temperature <br />) p <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.sjgov.org/ehd <br />^2 <br />Name of Facility: <br />Address: <br />F <br />IBSF <br />4SF fro' <br />Pago^of <br />FOOD PROGRAM OIR CONTINUATION <br />^2^ I f <br />V—\ A<—a ~~l H <br />6VA s \ J) <br />2. CATvr <br />Item/Location <br />(__________ <br />- Vv S__ <br />Food Safety Certification <br />Program Record: <br />Permit Posted Yes <br />Food Program Official Inspection Report <br />'O oQQ ' O^STA Date: IO-M - <br />^>c5\ McxAF 2A Clty: ZipCode: ' <br />Owner/Operator: / i Telephone: <br />Program Element: Program Record: <F F Inspection Type: <br />SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br />VVrV <br />Temperature 1 Location <br />Ffe-F c LvA • <br />15 I I— royA x <br />1 ?>5~F c_K&sl,j2 <br />%r S vl <br />Facility Hot Water TemperatureFll ) <br />Hand Sink: <>F <br />Received By / Title: <br />EH Specialist— <br />Time in: —| <br />EHD 16-24 (2nOpg) 4/3/13 <br />^O\\q- <br />Time Out: