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SAN JOAQUIN COUNNY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.s ov.org/ehd <br /> �l FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: to 5 } ' o } S G h o G( Date: _/ t/ _ Z <br /> Address: 3531 10 oOds 131vd city: 51K Zip Code: sZGL <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> RGLA <br /> � : of <br /> SB18O Posted C Yes 0 No Permit Posted O Yes -_ No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> I r ( / - o' an d VJ ON <br /> L — Lf d If - -- <br /> on Temperature Item I Location Temperature s' m I Location <br /> Troul5rnfl-c1< :.- 1 yl P Irrnul r l c/cc lr• ) �l7 <br /> y M . 13 S i r LJ a,rete 1A It <br /> Or Lc 44 ' F L.. IC (P)i' Hoyy l� <br /> Foo <br /> i d Safety,Certifiwtion - - Facility Hot Water Temperature , Warewashing <br /> Name: n /r1 ` / Hand Sink: 16;O of Chlorine: ppm Heat: eF <br /> Exp.Date: / ar washing Sink: 'F Quat.Amm.: ppm Other: aF <br /> Received By/Title: , <br /> EH Specialist: - Phone: <br /> ime-m 10 IS Time Out: Pagef <br /> EHD 16-24(2n°pg) 4/9112 FOOD PROGRAM DIP CONTINUATION <br />