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SAN JOAQUIN COUNTY <br /> � -OG <br /> 0: X <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ' •.. = ;P Telephone:(209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: j z - <br /> Address: �"�WH 6 rvt�I., e-� City: Zip Code: <br /> Owner/Operator: Telephone: U' <br /> f '41 136- Lj <br /> Program Element: j„ jj— Program Record: C Inspection Type: I(Ll(/L�- <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> f <br /> " C- , Z G <br /> (yu1 a r-A lvjj4 o taro/ nd- e-t1kviz '-,L <br /> � tGv�rl�- ,-� ,� rvvl vlJ�•�--- - <br /> 0)4 6( c?L, R dq QJ iLLC <br /> v a( ve n�Le 6 �a-� l 1, -Mf C <br /> .1 low <br /> Cu, 61i� a 4caj .n bija djad d-M y2.-lvyr -;? .+ Ice �a <br /> 44.00 <br /> f1tV,4 . aVit Al � <br /> a✓L. "r V, p/ ,e pith� al J ra r ov o <br /> I ..j,,. <br /> Item/Location Temperature Item?Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Ouat.Amm.: ppm Other: of <br /> Received By/Title. <br /> EH Specialist: 1 I, �� Phone: <br /> ime in: 7 Time Out: t] Page of <br /> EHD 16-24(2nd pg) 4/3113 FOOD PROGRAM OR CONTINUATION <br />