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Date: <br />Owner/Operator: <br />Program Element: <br />SB180 Posted <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />Q. j2-04? <br />ppm <br />Item/Location Temperature Item / Location <br />Food Safety Certification <br />Name:Chlorine:Fppm <br />Exp. Date:Quat. Amm.:Other:Warewashing Sink:°F °FPPm <br />w7 <br />Page of <br />FOOD PROGRAM OIR CONTINUATION <br />Temperature <br />g, <br />3' <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 />— <br />3-^ <br />e <br />Name of Facility: <br />Address: < <br />Warewashing <br />Heat: <br />Facility Hot Water Temperature <br />Hand Sink: op <br />Received By / Title: <br />EH Special' <br />time in: | <br />EHD 16-24 (2napg) 4/3/13 <br />Os <br /> Yes Rermit Posted <br />Fqqd Program Official Inspection Report r 3 <br />Date: ^/zg/Z6/4. <br />Oj Ao V <br /> Yes DI <br />pL2.Tr. <br />Program Record: <br />-3ionl0& <br />- 3^0 . <br />___r_ _TU^ it <br />Zip Code: <br />Telephone: 1 <br />mspeClonType..^^) <br />Re-Inspection on or After: • ' <br />u/^Tte/ &rcec-^-, - 119 <br />____T 7 <br />3< Q ^.$1 <br />- 2>- Czzm^----- <br />Time Ou.: L I C? p AA