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p rH SAN JOAQUIN COUNTY <br /> w ) -pG <br /> T. ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ��•..,s._..�;;p Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sugov.org/ehd <br /> L!FO R <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 73—C, 10 5 _r6 iv Date: 1 :2 - <br /> c� �^ i/t f i / � ' T <br /> q <br /> �/ <br /> Address: r �l City: j r Gr ( Zip Code: s <br /> Owner/Operator: !� n a^ . p r tAe � Telephone: <br /> Program Element: ��Lj o 1 Program Record: (0 <br /> dU 3 S 2 2 c, Inspection Type: Come ICA <br /> 56180 Posted D Yes ❑ No Permit Posted D Yes ❑ No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> rn IG n # S ; r.,lA5 . on. 1/ 212- 1& e, r C "-s <br /> Ck b CA r% SaCIO , szondGll lb +n5; <br /> G J a G r j art b '_1 <br /> Item/Location Temperature Item 1 Location Temperature Item I Location Temperature <br /> Food Safety Certification -Facility Hot Water Temperature Warewashing <br /> Name; Band Sink: of Chlorine: ppm Heat: 'F <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm other: of <br /> Received By 1 Title: � <br /> EH Specialist: Phone: -7 V? <br /> Time in: E Time Out: ;. l� Rage of <br /> U <br /> END 16-24(2n°pg) 419112 FOOD PROGRAM OIR CONTINUATION <br />