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ora"''"'.0 SAN JOAQUIN COUP f <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> 4��PO.RtN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: e ) Date: 17- If /I/ <br /> Address: g 12 S S. /Gra p City: Zip Code: qS 1 <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> �Cv1 � 'r <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 20 Pouse hold `_ 54 C004rol .oA hc, Ck PM ve soda <br /> ParIt6 <br /> GIt oc4, d 4 A rjAQ 6a'r bc4A � . r" <br /> TG01 u qrz(t PH � V ivla4QA <br /> 0J'15 ISP /1 PrP PAM C <br /> 1P Do AD) e a •r -.n prop rtrd7cl <br /> Item/Location Temperature Item/Location Temperature <br /> - <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Ouat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: / V J/� <br /> Time in: Time Out: 6 J Page of <br /> 01 'el <br /> EHD 16-24 (2n°pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />