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Zip Code: <br />Telephone: <br />Re-Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />1 <br />cl\UV> <br />V)oJceA <br />Item / Location <br />Name:PPm <br />Quat. Amm.:ither:Warewashing Sink:Exp. Date:°F PPm <br />Phone:1 <br />Time Out:Time in: <br />c.\ <br />.C, I <br />Name of Facility: <br />Address: —t ; <br />Warewashing <br />leat: <br />-C <br />J___ <br />Chlorine: <br />-1 <br />San Joaquin Couni <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 />Temperature <br />5 oa \ z <br />No <br />OX <br />CxJXrC <br />Item/Location <br />Page ■ of <br />FOOD PROGRAM 0IR CONTINUATION <br />EH Specialist: <br />EHD 16-24 (2Mpg) 4/3/13 <br />-Vo -kO^F <br />.oiV^C ______ <br />Temperature <br />°F <br />KSF__________ <br />MOF________ <br />MOF I <br />Facility Hot Water Temperature <br />Hand Sink: op <br />°F <br />K r^yL_ \ \ <br />. c\ - cos <br />5~C) — 0 \______ <br />Food Program Official Inspection Report______ <br />“Fr'X-Date: 'O~127~lcf <br />_______ . Ax City: S^MvV' ZipCode: °isx)S <br />Owner/Operator:_____________________GxWWYA ■ X <br />Program Element: y Program Record: Vj ,-A . <br />SB180 Posted Yes No Permit Posted Yes <br />I ■ ^>'0 <br />Received By/Title: ZX -/1.1 <br />Inspection Type: “4^-^ p <br />''-Cv Jr <br />\ Crl \ XT', <br />'^yi} \c^2, r <br />u cA<—eV <br />^3) cl' ^x <br />11) S-JA/x <br />Food Safety Certification <br />Cjrrr^y <br />WuO ~ \Q F______ <br />"V Vjka c <br />/) % \ c,.\^ ■ <br />Kx \2mF