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SAN JOAQUIN COUNT <br /> � �ft'cpG <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone.(209)468-3420 Fax.(209) 464-0138 Web:Www.sigov.ora/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 40f U- f o I Date: <br /> ddress. 7i 74. <br /> a Z d City: I roc zip code:Owner/Operator: Telephone:Program Element: Program Record: Inspection Type: U <br /> B180 Posted �j Yes D No Permit Posted U Yes C No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> I c n 4 <br /> a r.. re. Go Ore c -Ic <br /> 1) W !'► fi ice u ; 161'14 o r <br /> is b (0a ed d. rr c i n <br /> ,I {� <br /> -1 - oGr i Pr i ackl7n ', del <br /> ra ) r. to <br /> [� ✓ Loa J PI,ot, J le jrtt r d <br /> C4 1 0102 Cl <br /> Item/Location Tempeir6ttf,e Item!Location Tem eture item/Location Temperature <br /> ,Wod area � bc/r-{ Z-4, ) V/ <br /> Food Safety Certification Facility Hot Water Tempmature , - E a ; Warewashing <br /> Name: y to J Z Hand Sink: J�Uk of Chlorine: /0 yppm Heat: rI of <br /> Exp.Date: _ arewashing Sink: of Quat.Amm.: Ppm Other: -F <br /> Received By/Title: 6 <br /> EH Specialist: - Ph e: / <br /> Time In: Time Out: -f7� 0 Page of <br /> Vos 7 � 4G <br /> EHD 18-24 (2n°pg) 1118112 FOOD PROGRAM OIR CONTINUATION <br />