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Zip Code:ft J <br />Telephone: <br />Program Element:Program Record: <br />SB180 Posted Yes No Permit Posted Yes No <br />\) \ c/l Of' $ <br />A2- ' <br />CL <br />■/ CyCentre ■! <br />UJi K f/pptl 3 C C l e nJ <br />Item/Location Temperature Item / Location Temperature <br />Food Safety Certification <br />Name:Chlorine:PPm <br />Exp. Date:Warewashing Sink:Quat. Amm.:Other:F PPm <br />Phone: <br />Time Out: <br />EHD 16-24 (2^ pg) 4/3/13 <br />Received By / Title: <br />EH Specialist: <br />Time in: <br />u) cu Ai / r, ) J £ ’ r <br />\)»o \5_____ <br />Warewashing <br />Heat: <br />Facility Hot Water Temperature <br />Hand Sink: op <br />Inspection Type:y^ <br />Re-Inspection on or After: <br />°F <br />(2. <br />°F <br />Crr\ <br />City: <br />(Jar/y) /35~ f <br />Il0*3_______________________________ <br />ftf ftraq. ,k.^'ft <br />' ft / <br />rj Q <br />do o c' ft <br />Me/ v ■ c> I ci A 0a )______ <br />ur <br />Co nJ <br />Food Program Official Inspection Report <br />PtJch J Ccrrx T'Y/C'lf Dale: IO 2-H> <br />fid ci,y: <br />Jur iCry <br />Al O_____\/ \ pl a <br />. San Joaquin Cou. / <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 />cjJ____Cy<y/ <br />Name of Facility: <br />Address: q | <br />Owner/Operator: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br />!T)7n,:.LfJ _____9bc(/e ft^eKnQL/^(/ <br />Page of <br />FOOD PROGRAM 0IR CONTINUATION