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SAN JOAQUIN COUP <br /> y ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd <br /> C%FORia <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 4 �7–tj Date: — <br /> ddress: ( � City: Zip Code: <br /> lF <br /> wnerlOperator: Telephone:(��� 131�i_1f13a <br /> Program Element: Pfograrn Record: Inspection T pe r dl <br /> B180 Posted ❑Yes ❑ Permit Posted ❑Yes ❑1 Re-Ins ection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> vw✓fi" r.� AZ <br /> V -aw VAL <br /> 11- <br /> olN -j <br /> ndIkA4 1 l uridy - 10VF <br /> ;�►'a I i q I p)�`j Uzi S-e nm 1141 PAO] <br /> Audi f A"f-)F- V"dA Al- H' <br /> k ieb E lit 3VePkr16rcff ovo f317it: <br /> temperature Item t Location Temperature <br /> cA v1 yti <br /> n <br /> tl 'I <br /> Food 5 ety Certification r Facility Hot Water Temperature Warewashin <br /> Name: Hand Sink: of Chlorine: ppm Heat. F_ <br /> 0 <br /> Exp.Date: arewashing Sink: / i of Quat. Amm.: ppm Other: of <br /> Received By/Title: I <br /> EH Specialist: Phone: _ G7 <br /> Time in: `i V Time Out: 1 0` i o Page of <br /> I U <br /> EHD 16-24 (2n°pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />