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w: p <br />Zip Code:City: <br />Telephone:Owner/Operator: <br />Inspection Type:Program Record:Program Element: <br />Re-Inspection on or After:Permit PostedSB180 Posted <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />G <br />TemperatureItem / LocationTemperatureItem/Location <br />Food Safety Certification <br />Chlorine:Name:PPm <br />Exp. Date:Other:Warewashing Sink:Quat. Amm.:F°F PPm <br />Phone: <br />Time Out: <br />Name of Facility: <br />Address: <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.orq/ehd <br />Warewashing <br />Heat:°F <br />SO2. M 12 <br />Yes No <br />Food Program Official Inspection Report <br />Da,e: YJ-2.Z-K1 <br />Yes No <br />FaciIity Hot Water Temperature <br />Hand Sink: oF <br />Received By/Title: / <br />. H enlist: <br />Time in: I 0 ' <br />EHD 16-24 (Z'-pg) 4/3/13 <br />i so pase y <br />FOOD PROGRAM 0IR CONTINUATION <br />~F (