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SAN JOAQUIN COU <br /> .Z� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.s"gov.org/ehd <br /> �%FORD <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> ddress: A (v y© n �, ?XWVty: <br /> /(�a/// Zip Code: a41 <br /> ,C <br /> Owner/Operator: � Telephone: ,3 33—9rJ..l0 <br /> Program Element:/&7�� Program Rec rd: �J /� (�� Inspection Type: /1_. <br /> SB180 Posted ❑Yes ❑ Permit Posted F.Yes F1 Re-Inspection on or After: �:C� <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Q v fh 1W_.J ':a_ <br /> n <br /> ' w >r b <br /> (a.�I n nQ � d 4- <br /> nve bee Yi L� <br /> it' Q w O n L <br /> o e\j i aim c-e- o+ z' <br /> n-L�_n <br /> JAU ® ryv <br /> -z.-e- h& n+Y- Yl D <br /> -n cPrs ftLt nnM.e <br /> Item/Location Temperature Item!Location Temperature <br /> C—L►' <br /> - <br /> .....................-.........___ _ ' J ' I .. r 12� <br /> L4 rUmAix.rs33 _ 6P7CLU <br /> Food Safety Certification Facility Hot Water Temperature's,, Warewashing <br /> Name: � 4 y , -6Y� ��r. Hand Sink: �� of hlorine: ppm Heat: of <br /> Exp.Date: q arewashing Sink: 'F Quat.Amm.: JL, ppm Other: 'F <br /> Received By/Title: I <br /> EH Specialist: ^ L, . Phone:k/Vq <br /> Time in: \ C.�1''�l Time Out: — 1,✓S / Pagelof <br /> EHD 16-24 (2nd pg) 4/3'13 FOOD PROGRAM OR CONTINUATION <br />