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SAN JOAQUIN COUN'i . <br /> gyp....-••; C <br /> r. Z ENVIRONMENTAL HEALTH DEPARTMENT <br /> Q: <br /> _. 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> iP• Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd <br /> 'Q C I F p(Rte <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: eloo Date: <br /> Address: 2 r` ) f n r A City: S Zip Code: 9 S.2C b <br /> Owner/Operator: v 1 rTelephone: q33- <br /> Program <br /> ?2 -Program Element: Program Record: Inspection Type: FCA _ne <br /> B180 Postedes ❑ Permit Posted FPres ❑IV Li Re-Inspection on or After: <br /> OMNI OBSERVATIONS AND CORRECTIVE ACTIONS <br /> rni <br /> n� S ► . l - U e <br /> -- i" <br /> ItemtLocation Item 1 Location�i '�a�� �ti���wlwr�u,iii�i�t�u� ���` _._--�_____ ..___ <br /> k -0 __ f raulS��n �,2-Uw r� _ 7 f• �� <br /> l3s.r- <br /> 1rNc ol, <br /> d <br /> Safety CertificationuoFaci!ity Hot Water <br /> Temperature Warewashing <br /> Name: Hand Sink: F ';Chlorine: ppm Heat: 'F <br /> �6S L h n p 5 G rro.a 2 /LUQ _. CGn <br /> Exp. Date: arewashing Sink: of Quat.Amm.: ppm Other. �— 'F <br /> (�. 0. 1 /�1G'x c� <br /> Received By/Title: <br /> EH Specialist: - Phone: <br /> Time in: Time Out: F�> Page of <br /> 0 � �� d" <br /> EHD 16-24 (211pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />