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c'"'!Zip Code: <br />Telephone: <br />Re-Inspection on or After:SB180 Posted Permit Posted <br />= <br />4 <br />'^<s\ < <br />^-4 <br />s> <br />I <br />TemperatureTemperatureItem/Location Item / Location <br />Food Safety Certification <br />Name:Chlorine:°F <br />Exp. Date:°F °FPPm <br />Time in:Page of <br />larewashing Sink: <br />,r ■/ ------- <br />/V <<>#■/? <br />t (^> A <br />Inspection Type: <br />San Joaquin Count^ <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 />i___SL- <br />’ Facility Hot Water Temperature <br />Hand Sink: <br />Warewashing <br />[Heat: <br />zl <br />FOOD PROGRAM 0IR CONTINUATION <br />Food Program Official Inspection Report <br />DaK: <br />7:-^- <br />Yes No <br />EH Specialist: ' <br />Program Record: y <br />Yes No <br />_____ <br />- <. 1 cU <br />i/TjTfJo. <br />i/u <br />\0aaA / a r Vjz. <br />Quat. Amm.: <br />'•""'"'ZW/.Z/ * <br />EHD 10-24 (Z-^pg) 4/3/13 <br />,,, <br />Name of Facility: <br />Address: >—7 A/ <br />______ //L'l JV / <br />Owner/Operator: / /T /. <br />Program Element: , //< P------- <br />—ty y = <br />p-^gr' <br />-----1 <br />_____ <br />- Vb rp /<X- c4 <br />-I J X/kz- f <br />4>Zk>\i I f <br />C- -X <br />Aoir <br />. z?>|*t A% j 1 <br />A' _____ <br />ppm <br />Other: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />1/yZ^y/X ~~~ Xz/A {/ c-_ <br />-< — (IP F <br />-Pt <br />'•■<A <br />|£r