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°p4H1y' SAN JOAQUIN CO*Y <br /> n . <br /> y ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> :a Telephone:(209) 468-3420 Fax.(209) 464-0138 Web:www.siaov.ora/ehd <br /> q[7FiiAi' <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: u O Date: �/ p <br /> Address: 6/ 2 <br /> U/ City: � Zip Code: <br /> Owner/Operator: Telephone: L{6 G-8 7 9 / <br /> Program Element: Program Record: � D/49 b z/ Inspection Type: ` 0 <br /> SB180 Posted Yes No Permit PostedY No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> I Ohser <br /> S ` <br /> ZQ <br /> ,!e <br /> r <br /> o <br /> ao � <br /> sn Algor AIR[-e.�i nes4moJAW10 144,�_5rn <br /> Is . <br /> �t and <br /> :hC <br /> 74 t <br /> 14 0ea a k204 2. <br /> L <br /> wr <br /> / 1 l` fl o <br /> hem/Location T 1� <br /> emperature _m/Location I Temperature <br /> _ <br /> ---- <br /> Z <br /> —_> <br /> Y yr Facility Hoi Water Temperature �I } Warewashinq <br /> Food Safety Certification I <br /> Name Hand Sink: "F Chlorine: ppm ;Heat: F <br /> Ex Date: ---- -- -- - <br /> P� Warewashing Sink: eF Ouat.Amm.: ppm ther: of <br /> Received By/Title: <br /> EH Specialist: A. Phone: `_7 <br /> ime in: Time Out: . Page f <br /> EHD 1624 (2W pg) 4/3/13 <br /> FOOD PROGRAM OIR CONTINUATION <br />