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SAN JOAQUIN COUI,_ f <br /> Z ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> a4crfo*N;P Telephone:(209) 468-3420 Fax:(209)464-0136 Web:www.siaoy.orD/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT 5�cp�r4.t ! <br /> Name of Facility: ^­0 Date: �� 7 <br /> Address: 141 q e?' City: C_,0V-A0-'7 1e152 <br /> zip Code: �5 67 <br /> Owner/Operator: 7 Telephone: 41741_11779 <br /> Program Element: /& Program Record: 009 0 . & O 2 <br /> Inspection Typ �n <br /> B180 Posted Yes No Permit Posted Yes No Re4nspection on or After: <br /> RRECTI,.VE ACTIONS <br /> i1a 2L <br /> (sli�o/o-d <br /> he G 1 r. <br /> r12 C�— Of",011 t� IX — <br /> ka <br /> I r cc rtG L <br /> r --. <--4- 4-4 r to t Gel v� <br /> Lc <br /> -- .... .......-. <br /> l� — r COn-i n <br /> drt f h <br /> hOf p V e s F <br /> item/Location _ Temperature ( _ _ Item/Location ----1-Temperature <br /> Food Safety Certification r Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: 'F_ Chlorine• PPM ,Heat: �F <br /> Exp.Date: arewashing Sink: 'F �Ouat. Amm.: PPM IOther: eF <br /> Received By/Title: <br /> f <br /> EH Specialist: Phone: / <br /> Time in: 5 Time Out: , Paget of <br /> EHD 1624 (2^pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />