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SAN JOAQUIN COU, <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �q.. ;P• Telephone:(209) 468-3420 Fax: (209) 464-0138 Web:www.segov.org/ehd <br /> L�FORN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: -!,0 Date: i <br /> _ Z _ <br /> Address: 2� C-'1 ; City: Ta <br /> `- Zip Code: �w cJ 30 <br /> Owner/Operator: � IQ r Telephone: ()_ -' <br /> Program Element: 1'^ Program Record: S •2-c S Inspection Type: V <br /> SB180 Posted Qe9 No Permit Posted Yes No Re-inspection on or After: <br /> OBSERVATIONSAND CORRECTIVE ACTIONS <br /> c" e C <br /> C- e e e <br /> P) or\e <br /> � L - _ 1 \ 1r r4 _ 1 <br /> Q <br /> u _ <br /> C lpoice <br /> � e <br /> b9 ' e <br /> Item/Location Te perature Item/Location Temperature <br /> C-0c <br /> \61 <br /> Food afety Certification Facility Hot Water Temperature Warewashing <br /> Name: + _Y�Q Hand Sink: `0"` 'F Chlorine: ppm Heat: 'F <br /> Exp.Date: \ rewashing Sink: kS 'F Quat.Amm.: l"1, - ppm Other: 'F <br /> Received By/Title: <br /> EH Specialist: - Phone: <br /> Time in: 1 22 Time Out: 1 O Page f <br /> EHD 16-24 (20°pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />