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0¢:4 N. c SAN JOAOUIN CONY <br /> 0: Aa ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sigov.orq/ehd <br /> LiFoaa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: y v!%i'� Date: j <br /> Address: V City: f e, 4/: Zip Code: <br /> Owner/Operator: /�, //�` `�V wl Telephone: <br /> Program Element: �,3 Z l/ Program Record: / Inspection Type: <br /> SB180 Posted ' Yes F1 No Permit Posted n Yes 7 No! Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 1 _K Ll [f /C- OC 1. <br /> C!' ( A <br /> 170' F 77 C — <br /> 1$0 <br /> - <br /> Item/Location I Temp rature Item!Location Temperature <br /> - <br /> Com_ <br /> Food Safety Certification Facility Hot Water Temperature' Warewashing <br /> Name: / h,`� Hand Sink: {/i of Chlorine: ppm Heat: �i,, F <br /> lX <br /> Exp.Date: Warewashing Sink: s % of Quat.Amm.: PPM Other: of <br /> Received By/Title. <br /> EH Specialist: Phone: <br /> i <br /> Time in: / Time Out: Page of <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />