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Date: <br />City:Zip Code: <br />telephone: <br />Program Record: <br />SB180 Posted <br />34 <br />11 & F <br />\r& <br />03 1 c cCS <br />V-UF- \fle \/ i I'Fj-ytc cFr - <br />Temperature Item / Location Temperature <br />\c\ <br />Chlorine:°FPPm <br />Exp. Date:Warewashing Sink:Quat. Amm.:Other:°F °FPPm <br />Received By / Title: <br />EH Specialist: <br />Time in:Time Out: <br />EHD 16-24 (2nd pg) 4/3/13 <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 />OBSERVATIONS AND CORRECTIVE ACTIONS <br />F <br />Name of Facility: <br />Address: <br />Warewashing <br />Heat: <br />Item/Location <br />\ X X XxxJ <br />Food Safety Certification <br />Name: <br />Food Program Official Inspection Report <br /> Yes I <br />Facility Hot Water Temperature <br />Hand Sink: op <br />o I2OF <br />Page^ of y <br />FOOD PROGRAM 0IR CONTINUATION <br />Inspection Type: <br />Re-Inspection on or After: <br />> <br />3 <br />Owner/Operator: <br />UOF <br />Phone: Hlpfl -03KF <br />I rn™ <br />Program Element: <br /> Yes Rermit Posted <br />f\rA oV-<~3> <br />FivyF -F •_______ <br />‘ kA