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P411" SAN JOAQUIN COUI, t <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.slgov.orq/ehd <br /> �/FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: �a4 r Date: <br /> Address: % t 1 r S i City: Zip Code: 9 S.3 n <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> U S re S Oro cWAC1 ler <br /> W C4 rM 00 10,i, qJ' CG.,,e L Wee A(. <br /> lary <br /> �i()•1. �'�S �r �P��C�vors d CA 1�. <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification L4a47-ility Hot Water Temperature Warewashing <br /> ----- ---— -- -..__.._........Name: IV j A nk: ofPpmHeat: of <br /> Exp.Date: shing Sink: 'F Ouat. Amm.: PPM Other: "F <br /> Received By/Title: <br /> EH Specialist: 7 - ' "V Phone: <br /> ime in: Time Out: Page of <br /> EHD 16-24 (2n'pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />