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City: <br />/ <br />No <br />f <br />I L <br />J <br />Food Safety Certification <br />Name:Chlorine:°F <br />Exp. Date:luat. Amm.:°F °Fppm <br />Phone: <br />Time Out: <br />C <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.sigov.org/ehd <br />EH Specialist: <br />Time in: <br />fo < <br />Facility Hot Water Temperature <br />[Hand Sink: <br />Iwarewashing Sink: <br />Received By / Title: / 3 X I <br />EHD 16-24 (2nd pg) 4/3/13 <br />-^2, Page ofr-^ <br />FOOD PROGRAM 01R CONTINUATION <br />-K Aj2- rlA^h\, <br />Item/Location <br />Name of Facility: <br />Address: —> x-? f zi x z <br />Program Record: <br />Permit Posted Yes <br />Owner/Operator: 1 ~i <br />Program Element: <br />SB180 Posted Yes <br />Warewashing <br />ppm |Heatr~ <br />Other: <br />/TX- > <br />s» <br />Temperature <br />____r___________ <br />Yes No <br />M A S~'p <br />Si <br />QsJ^JX. <br />Temperature <br />Food Program Official Inspection Report_______ <br />. Date: <br />City: <br />Telephone: <br />Inspection Type: ^7^^ <br />Re-Inspection on or After: / <br />________z_____________ / / <br />-l0d Jf>Cf / C( <br />Got' K' 4^/? A ________________ <br />LG') O-a. i/XgJi/A ( <br />S' [ Xu 1 Y~r <br />L^> —( oXG < <br />/>•■' r"^p—> ‘•>2\ <br />- —. <br />A f « <br /> (a/^ <br />lioX 1 v ' ______ _____ <br />4u^ckJ <br />Item I Location <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />I ■ ><•- ---------- - -----— . _ <br />A(o <br />(^acI Ml __ <br />O - A ' <br />„ cM <br />$7 Y^]A -ok__vv^> A <br />X <^x) » | <br />(A^A ^-7s7T <br />c^d \k ( <br />/4 ds&X <br />X rz^izi X