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4-i <br />City:VU <br />c <br />^14 <br />Clo <br />5S3IW) <br />V£S>ElkAjgXZ—y'V"'* <br />o <br />Sh v~Gg <br />ibJLr <br />13S H 6^- <br />'->v - <^z. <br />ZQC^n <br />J <br />Chlorine:Name: <br />Other:Quat. Amm.:Warewashing Sink:Exp. Date:°F°F PPm <br />T <br />FOOD PROGRAM OIR CONTINUATION <br />Temperature <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 />°F <br />a <br />Co <br />Gxre OX <br />Name of Facility: <br />Address: <br />Program Record: <br /> Yes Permit Posted <br />UT) <br /> Yes I <br />, SV~\__________________ <br />Food Safety Certification <br />/OF <br />. ' emperati ■» <br />\3$ r <br />btt <br />3i I- <br />...I CMI- <br />Facility Hot Water Temperature <br />Hand Sink: op <br />Owner/Operator: <br />Program Element: <br />SB180 Posted <br />OLa-ACj/ <br />Received By / Title: <br />EH <br />E” ‘T'.'SS^VA <br />EHD 16-24 (2"° pg) 4/3/13 <br />)VrM \ c£ <br />uko i res <br />Warewashing <br />ppm Heat: <br />Phone: <br />Time Out: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />r- ers_______ <br />\CO CIVMrA <br />IIP.. . <br />y,-^. <br />C V - \ yJO <br />vi-C - \ t~c <br />WfO - \ <br />Item / Location <br />C VxalI<^ <br />-uS ...~ <br />Food Program Official Inspection Report______ <br />______Date: IS- I k <br />SO Zip Code: 0)5 2 0^ <br />Telephone: <br />Inspection Type: « <br />Re-Inspection on or After: <br />________H- - <br />’y ‘Sc <br />Yr-zT^-?^ CM-X-jX -______—- <br />VZMF catHc. <br />I Fry IMC> i~