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SAN JOAQUIN COUN1 . <br /> 'ya 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 /> <<FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ` Uv ; Date: 5_/2 <br /> Address: } C c j �„ City. �' 1 Zip Code: <br /> Owner/Operator: a C Telephone: �. <br /> Program Element: 16Q 1D Program Record: 0 4 7 C7 Inspection Type: Q.�,� A Vit. <br /> B180 Posted ❑Yes ❑ Rermit Posted O Yes ❑ I 7 Re-Inspection on or After: <br /> OBSERVATIONS AND::CORRECTIVE ACTIONS. <br /> l ✓ C c <br /> _i <br /> i t Q l' <br /> n7atylv QS AA havi <br /> kpnAC <br /> r 5 A 1,1&k Awl <br /> r <br /> S r <br /> 1 4 0 <br /> WA A <br /> A on <br /> t S If -,z—n ��+e y— ore_ <br /> fi art A a <br /> r <br /> r Pan <br /> /o lk /1-eac _ <br /> Item/Location temperature Item t Location Temperature <br /> .._.. _ .. - <br /> Food Safety CertifIcation Facility Hot Water Temperature �- Warewashing <br /> Name: Hand Sink: 'F Chlorine: ppm Heat: °F <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm iOther: of <br /> Received By/Title: ��•� y �� '[' - fin'.Ot r ���� <br /> H Specialist: �� � �a Phone: Zli 5 D S57 <br /> - <br /> ime in: Time Out: / 99 I D Page of <br /> EHD 16-24 (2n'pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />