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w: <br />. "HaQa^ YyS^L <br />vm, dc^as <br />IS <br />n-OF- MjiaS-vCa 4- <br />c^rv€oved <br />yvzN i <br />TemperatureTemperatureItem I Location <br />Food Safety Certification <br />°F <br />°F <br />Name: <br />Exp. Date: <br />hlorine: <br />luat. Amm.: <br />Warewashing <br />Heat: <br />Other: <br />ppm <br />PPm <br />San Joaquin Cour <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 />EH Specialist: <br />Time in: <br />Name of Facility: <br />Address: <br />Owner/Operator: <br />Program Element: <br />SB180 Posted <br />EHD 16-24 (2napg) 4/3/13 <br />Facility Hot Water Temperature <br />Hand Sink: op <br />Warewashing Sink: op <br />c\q^e , <br />on Si-yc • <br />POHm , <br />__________ r <br />Phone: <L0q- <br />Time Out: Pa9e [of <br />FOOD PROGRAM 0IR CONTINUATION <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />Q) Vi U p DO C in: <br />'rn\ c crreaqn jenc\o;Are. <br />(n9clg. <br />-pcinoi-f- is od'_____ <br />- 'ferfcg LCuuA Ot e - <br />wMer— <br />-TWr-6 cai£ cx ^0^ <br />CI or pr?^v' eV?. <br />i r/xpaccAnG / fuvcateSo: <br />- fer yvCU^r ftorCTwXk is~ <br />lOOF. <br />J) E>riSte+ <br />__ -no VrdwoSAv SjgafcJv* - <br />-OF_____________________ <br />Wv^ (AA-pS- Qi- ~_______ __________________ <br />(uT WLfcfrt CHAT’S .do noT ICQ-- <br />- yio -ferdl yvQSh StZA-tTcTH -' corygCAt^d J <br />Item/Location <br />\2g?p. ' <br />m PcvM ^q-|cr <br />This io j>-€ <br />______Food Program Official Inspection Report________ <br />SA- facile Hwual EgShvcd_______________Date: <br />\44 w fiFfo City: s-toOTryH ZiPc°de: <br />SA. (jgcXZXe pCAriSb CbvvzAA_____________Tetephone:___________ <br />\ 6 program Record: pg ( TEr Inspection Type: <br /> Yes Rermit Posted Yes I Re-Inspection on or After: ,