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oga"s. SAN �JOAQUIN COI �TY <br /> y ENVIRONMENTAL HEALTH DEPARTMENT <br /> Q: a <br /> - 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �q..• •.�;;P Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.slQov.orq/ehd <br /> �1FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: 1 - /[ <br /> Address: S_ in J/�17L_ City: Zip Code: <br /> Owner/Operator: Q Telephone: <br /> Program Element: /,r�Z Program Record: Inspection Type: e/ <br /> S8180 Posted es No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> V -1hu 471 <br /> Item/Location Temperature Item/Location Temperature <br /> I L7 <br /> 1,41 wuvt'v Ir o v( wip✓✓Vq ✓ �� <br /> Food Safety Certification Facility Hot Water Temperature M Warewashing <br /> Name: ,l _.._.... _.. _...----- <br /> �� 1 I, /� Hand Sink: of Chlorine. ppm Heat: (00 <br /> of <br /> Exp.Date: J (rf I (] arewashing Sink: of Ouat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: I�pA, Phone: `_ <br /> Time in:, I ,qo- Time Out: "� Pag67 2 <br /> f <br /> EHD 16-24 (2^ pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />