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SAN JOAQUIN Gout <br /> )�•�a.CSG <br /> 4' ENVIRONMENTAL HEALTH DEPARTMENT <br /> to: X <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.s4gov.org/ehd <br /> 4C(FORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ��� - ` 1�` iC �, Date: i, �-(�- <br /> Address: ?-2 6\ 1 `�� I, City: ;�� Zip Code: a �77 <br /> Owner/Operator: S`n ( \ l� Telephone: _ q <br /> 00 <br /> Program Element: 1 b Program Record: Ste 2- Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> "T�l e cr e SQ0-e 5 o i l k2 d J3c-R -- <br /> _ 1� 0\ V QC. C1 <br /> 2 5 <br /> e <br /> e <br /> kiq ee ' \Ik1zC c <br /> T 0. <br /> e e off- �. <br /> _ e1 <br /> 1 s <br /> \ <br /> " ItenVLocation 1 Temperaturepe <br /> Item/Location Temperature <br /> c e. _ �.F `�b '4t <br /> 'tet. I`= <br /> ,��, <br /> Food Safety Gertifica�on - � Facility Hot Water Temperature I Ware-washing ; ;x <br /> Name: 1E, S ON Hand Sink: F Chlorvng: ppm Heat: F <br /> Exp.Date: 1� �` \� arewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: 1, �1 Phone: �_O <br /> at-0-2- <br /> Time in: 12 >j�3 Time Out: , `XJ Page�f <br /> EHD 16-24 (2^ pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />