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SAN JOAOUIN COUIr <br /> a y� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.s ov.or /ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Cir r Cit Zip Code: <br /> ddress: WAV y' q <br /> Owner/Operator: Telephone: i'T/ 3 ;20 0,3 <br /> Program Element: a Program Record: f� �/ �3 Inspection Type: 4� <br /> B180 Posted(sYes ❑ No Permit Posted Yes ❑No Re-inspection on or After: <br /> I <br /> OBSERVATIONS AND CORRECTIVE.A1vTIONS <br /> 2 _r Y-e- rr-c cam_ <br /> c ' <br /> r' <br /> YS rl-e r N r n A C <br /> ,-a„'G ra w' <br /> C r m o GCS�► -a <br /> c4 k1a n r- ho <br /> a <br /> _� I c-(-a -i brat r A lyY2.Ct c t-t o r <br /> ck rea. :3 yz Cs <br /> J <br /> vu <br /> CLP-trz�Z 1 60-60 Ve- <br /> y-&4 <br /> Qy-& CO--Y~ LJ e. GL <br /> t'ow U r' D CA:4-r 0-7 S 6o r-,P--.e_ <br /> Rem/Location Temperature Item/Locatlon Temperature item/Location Temperature: <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: QO'F Chlorine: ppm Heat: `F <br /> Exp.Date: A War as ing SI k: ! 1 aF Ouat.Amm.: ppm Other: of <br /> Received By/Ti I <br /> EH Specialist: /„ _ _ L, . Phone: ,r �2 O 9 1'?ime in: q 5 r v[r✓ C:�LUL Time Out: Page of <br /> EHD 16-24 (2' pg} 4/16!12 FOOD PROGRAM O1R CONTINUATION <br />