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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • c ;p• Telephone: (209) 468-3420 Fax:(209)464-0138 Web:www.sl4ov.org/ehd <br /> 4��FORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: �� / ;�R 'f SLIt,��.Y C`v a I,�j" Date: / <br /> Address: /6(p 9AWlel— City: Pr_, Zip Code: <br /> Owner/Operator: Hyl`f�_ OS _ _21 !jZA! l �g�_7YI9 <br /> � <br /> Program Element: 0 -7 Program Record: PO.:5—V 7 i33 Inspection Type: / T <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> a/�/r✓cam -.,� r.r, f <br /> Item/Location TemperatureItem/Location Temperature <br /> --_—._.. ...... <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> d , c,s jf� Hand Sink: / —"-- F Chlorine: ppm Heat: 'F <br /> Exp.Date: u .�� Warewashing Sink: /Z'C �F Quat.Amm.: ppm Other: �F <br /> Received By/Title: c <br /> EH Specialist: Phone:Ctt� <br /> Time in: k? <br /> ?x. p Time Out: 1 . g, Page of I <br /> EHD 16-24 (2nd pg) 4013 1 FOOD PROGRAM OIR CONTINUATION <br />