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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ 600 East Main Street, Stockton, CA 95202-3029 <br /> c'vFoa�P Telephone: (209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.om/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: ICity: Zip Code: J✓JJ <br /> 7 <br /> Owner/Operator: one <br /> Pogram Word: IspectioType:Program Element: zi <br /> B180 Posted PIros ❑ No Permit Poste es No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> o- Gu wa Arm Y <br /> W.aI kt)Av t- VIC A4 "C <br /> 91r- <br /> 8 <br /> /0Q <br /> .t-091 UAdo <br /> on yield e07dk4v�t , <br /> 40 o .l- <br /> a <br /> (Location ' .._I Temperetur MMJJFXO/�� <br /> -'Food Safety Certification Facility Hot Water Temperature <br /> Name: Hand Sink: -F Chlorine: PPM r <br /> eat: 'F <br /> Exp.Date: Warewashing Sink:- of Quat.Amm.: ppm er: .F <br /> Received By/Title: <br /> EH Specialist: Phone• �ta0 <br /> ime in: Time Out: 3:-3� Page <br /> EHD 16-24 (2� Fg) 11/209 FOOD PROGRAM OIR CONTINUATION <br />