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0: <br />Zip Code: <br />Telephone:Owner/Operator: <br />Inspection Type:Program Record: <br />Re-Inspection on or After:SB180 Posted <br />J <br />C <br />4 <br />•0^ <br />Item / Location <br />Name:Chlorine:ppm <br />Exp. Date:Quat. Amm.:Other:ppm <br />Received By / Title: <br />Time in: <br />Warewashing <br />Heat: <br />Temperature <br />San Joaquin Coun' <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 /> Yes I <br />EH Specialist: <br />EHD 16-24 (2~pg) 4/3/13 <br />Facility Hot Water Temperature <br />Hand Sink: op <br />Page^of^ <br />f€od program oir continuation <br />°F°F <br />°F <br />Item/Location <br />-TT -JL rffl- L. - <br />Food Safety Certification <br />Y A/\ <br />Food Program Official Inspection Report ______ <br />Date: <br />ec, C"y <c7-Li ^lp^ode: <br />Name of Facility: <br />Address: | <br />Program Element I / A. <br />* Yes Rermit Posted <br />s__ <br />'—u// do.^ <br />/P.Ti/C-yL)_______ <br />V Phone: <br />Warewashing Sink: <br />zx At^Vl i <br />L-' ------»— <br />AAttu-C A j—c .. v <br />Temperature <br />i | » <br />- - z -------> <br />~~ Ho----p <br />-Gw i i----—-j— <br />cluj: <br />— <br />aJ.U <br />-6/^-^.— ——— <br />g A U<—•—Ch> pr^- <br />OBSERVATIONS AND CORRECTIVE ACTIONS_______________________________ <br />PA //_( T " <br />, -tTS't .■U.i’- c’ If_____________T__f__ <br />Pg/Pp s:A^/-Kb ~ <br />C&, ^VTPg e/crH-i C <br />n'n4Lg__________ _ ____ <br />■’ 4/ 2jl>~ )p e<L <br />f<9<9 fpM civic rU 3^ C^IoFd kelp <br />pz. -P>r ^ch: \ <br />MP <br />Tb-vJ_,___Th bY-o. <br />dPg - — <br />Time Out: f