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Zip Code:City: <br />Telephone:Owner/Operator: <br />Inspection Type:Program Record:Program Element: <br />Re-Inspection on or After:Permit Posted YesNoSB180 Posted Yes <br />Co( d■lALi <br /> <br />Item / LocationItem/Location <br />Food Safety Certification <br />IChlorine:°FName: <br />:uat. Amm.:Warewa:link:Exp. Date:°F°F ppmb, <br />Phone: <br />Time in: <br />San Joaquin Col :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 />Name of Facility: <br />Address: <br />T** <br />Facility Hot Water Temperature <br />Hand Sink: op <br />Z"'/ <br />Time Out: q Pag^pf <br />FOOD PROGRAM OIR CONTINUATION <br />^OBSERVATIONS AND CORRECTIVE ACTIONS <br />' ) .j£^vc/Ojrf ________________ <br />6dLA <br />No <br /> a <br />( cAek <br />Warewashing __ <br />ppm |Heat" <br />Other: <br />Temperature [ <br />I A latex _____ <br />f A> =- V' 6 d <br />Food Program Official Inspection Report <br />A Date' 1 I’ll I '-j <br />I z u city' <br />ru ___________r <br />zx- <br /> .'te. <br />Received By/Title: <br />EH Specialist: <br />EHD 16-24 (2ndpg) <br />CjO ^^/<Lri/A<X- <br />0 Ito 7 L <br />O-Vc/X 1 _________