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SAN JOAQUIN COUN� <br /> C' <br /> X ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.slgov.org/ehd <br /> �tFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ? ' Date: 3 ' j1-1 <br /> Address: City: Zip Code: <br /> s r� d �� „ 9s23 f <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> v -1 <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> � a OBSERVATIONS AND CORRECTIVE ACTIONS <br /> f � <br /> re <br /> t00 L16 <br /> Ci 11 d C' r <br /> trec fodG <br /> oJ#' i <br /> n <br /> I <br /> Par I . C le to c, cl s 6-ko f <br /> , n G WOO d I �S <br /> iv C; 10 C Ve . - C ,IF P <br /> �; ,, <br /> J; r\ Use 0 S c7 re h <br /> e r c duc a 5 6 j ric hOP- he <br /> rci,ind 40 d 1 <br /> ac C rojo er S ca l U S { 1 <br /> . a n ties ' ? h . r ! iC lar <br /> qn d ItA e if e � . <br /> 1 7ne n r n S n, o r a r cc S u h c If Q rn o/P r G r e <br /> / (Al a 16i rC ai`�rCOP , 0, 1 'S'Ps;'.0 <br /> 0� <br /> or V� -c GYrt? C1 1r >>�a k <br /> Item/Location Temperature Item%Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: Ppm [Heat: of <br /> Exp.Date: arewashing Sink: of Quat.Amm.: ppmther: of <br /> Received By/Title: <br /> EH Specialist: / - j Phon <br /> Time in: Time Out: Page.of <br /> EHD 16-24 (2°'pg) 4/9/12 FOOD PROGRAM OIR CONTINUATION <br />