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�o°Q"�" SAN JOAQUIN COUI <br /> ••. ...... <br /> y� ENVIRONMENTAL HEALTH DEPARTMENT <br /> •'. _ = 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.s'gov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 1 Date: <br /> Address: o O VM r� City: L Zip Code: <br /> Owner/Operator: T`vim v+b��� � 2d <br /> Telephone: <br /> G1 �Z 15 <br /> Program Element: lfo 2 Program Record: 110 05 (00 <br /> Inspection Type- r%s- <br /> B180 Posted Yes ❑ Rermit Posted Yes ❑ I Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> lot,e.e� <br /> P. .� d 1G$ �Y�f YI'�i'il <br /> Item/Location ,s,��;i, Item 1 Location Temperature <br /> YYl 11C o r <br /> L� 1i M Lino Atit :5 60 V' HVL- e P- I(4o or <br /> cLOD r E-�U b 3r-I - -- - <br /> .: e Gam j _Facility Hot Water Temperature Warewashing <br /> Name: 61616k <br /> Men I z Hand Sink: � 12-0 'F Chlorine: � ppm Heat: u� of <br /> Exp.Date: _a-7 arew� Siin l LN of Quat.Amm.: 0-j0(!;>ppm lo <br /> ther: of <br /> Received By/Title: t�AA <br /> H Specialist: OAI; /. -v, Phone: <br /> ime in: 0 .IS V Time Out: Page.,of 2 <br /> EHD 16-24 (2nd pg) 4/3113 FOOD PROGRAM OR CONTINUATION <br />