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°"�" SAN JOAQUIN COUN� <br /> �o. .00G <br /> N: <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> x <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: f 1 C1 I Z er C L Date: 5-15 <br /> Address: 18CSte_ City:, , 03&1_ Zip Code: <br /> Owner/Operator: 0^. S�1 10 l 1 ��I Q W �J Telephone: <br /> Program Element:\ C,J\j,,2 Program Record: T V 1 Inspection Type: I <br /> P-18-0posted �l ❑Yes ❑ Rermit Posted ❑Yes ❑ I Re-Inspection on or After: C�- <br /> Tin <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> oti-e <br /> F01-C;1 <br /> ItemiL cation Temperature m 1 Location perature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name. Hand Sink: of Chlorine: ppm Heat. of <br /> Exp.Date: arewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: 'O - ,o r Time Out: t O! LSJ�off, Page,of I <br /> EHD 16-24 (2n,pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />