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, P4 .C'ao SAN JOAQUIN COUP <br /> • a` �+ ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • q.... a` Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sogov.org/ehd <br /> �IFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: o (UAA�W If Date: <br /> Address: City: Zip Code: N <br /> Owner/Operator: a -'A C� (*YZ 'a Telephone: 1 <br /> Program Element: Program Record: Lf Inspection Type: o <br /> B180 Posted es No Permit Posted Yes o Re-Inspection on or After: <br /> 06 <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> gods sk��- <br /> - zo <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: 'F Chlorine: LPPP <br /> Heat: °F <br /> Exp.Date. arewashing Sink: °F Quat. Amm.: Other: F <br /> Received By/Title: Y7Q, r" O. ,z j <br /> EH Specialist: ` Phone: <br /> Time in: Time Out: Page of <br /> EHD 16-24 (2""pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />