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OBSERVATIONS AND CORRECTIVE ACTIONS <br />CM <br />QQF. frdjuU 10(9 p -IOSF.K <br />Item/Locaton RS Temperature TemperatureItem! Location <br />Name:Chlorine:°Fppm <br />Exp. Date:Quat. Amm.:Other:°F °FPPm <br />Warewashing <br />Heat: <br />EH Specialist: <br />Time in: <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 />Received By / Title: <br />EHD 16-24 (2"»pg) 4/3/13 <br />Name of Facility: <br />Address: <br />Owner/Operator: <br />Program Element: <br />SB180 Posted <br />Xan <br />Non-F <br />i <br />Page^of <br />FOOD PROGRAM 0IR CONTINUATION <br />IWF ■K-foE. <br />PCW^ -• <br />£fvif4‘ <br />As XI? <br />phone: <br />Time Out: <br />Food Safety Certification Facility Hot Water Temperature <br />[Hand Sink: oF (__________________________________ _____ <br />Warewashing Sink: <br />Food Program Official Inspection Report______ <br />Date: <br />F n + City: Zip code: <br />Ticup 'NC Telephone: <br />Program Record: p £ C\ ^2-^ Inspection Type: <br /> Yes Rermit Posted Yes I Re-Inspection on or After: <br />-4). .fax-of ___________ <br />0 dal <br />- soMc arrows of k <br />of< off > <br />Tn) liTfU? cubits <br />-u cIHeyinc -W <br />•~dF' <br />- wafh <br />(0} FVF ng >________________ <br />~^nJwdsVi S ut M\naU -tzt <br />-coofej-\ C0 Fun -40a p- <br />Codiaf'