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City: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />JAC&'fvut Cm/j <br />TemperatureItem/Location Temperature Item I Location <br />Food Safety Certification <br />San Joaquin County <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 />eego: <br />> No <br />Name: <br />Exp. Date: <br />Received By / Title: <br />EH Specialist: <br />Time in: <br />Warewashing <br />Heat: <br />Other: <br />°F <br />°F <br />Page^Z of^ <br />FOOD PROGRAM 0IR CONTINUATION <br />w <br />No <br />Facility Hot Water Temperature <br />Hand Sink: _____ _ <br />Warewashing Sink: op <br />1 <br />j^C(C <br />Chlorine: ppm <br />Quat. Amm.: ” <br />/O.OD TimeOut: <br />EHD 16-24 (2"dpg) 4/3/13 <br />-MW -|T>^r <br />Cm <br />M-r-mF <br />vL) ’■^4 kwl d - (. ____ \_____________________ <br />/7l P j -aclckA ///^ <br />s'4/aaA(/^ ~ / <br />________ Food Program Official Inspection Report <br />Name of Facility: S Rd? Date: | <br />Address: City: Zip Code: <br />Owner/Operator: (/ j-----Telephone: <br />Program Element: Program Record: P/2^ Inspection TyperJ^^p (fRfrtZ <br />SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: