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"� SAN JOAQUIN COL Y <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.si-ov.org/ehd <br /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: fl Date: pp <br /> Address: i 2,Q 0n Di 1c) City: C_VZip Code: <br /> Owner/Operator: Telephone: <br /> 013P-11/ <br /> Program Element: Program Record: (� n O I �i Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> GbC)(.e r LS Yvo+ CnC J fir) <br /> �-�- u R°-j• i�a,l� lam. 4 I r o r Lj�,W-P-yl- <br /> G (A-r COU 1 a <br /> n P) xyl r mc,y-2._ <br /> Co 1 <br /> 7A (�e <br /> YL <br /> Item/Locati Temperature Item f Location � � Temperature <br /> r- a r - - <br /> - ----_ -- <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: A )1a�� Hand Sink: © � of Chlorine: �Q PPM Heat: of <br /> Exp. Date: i arewashing Sink- Other:of Quat.Amm.: PPM of <br /> Received By/Title: <br /> EH Specialist: , Phone: q53— <br /> Time <br /> 53`ime in: p: 56 Time Out: ;1 L© 6 Page f <br /> EHD 16-24 (20°Pg) 413/13 7 FOOD PROGRAM OIR CONTINUATION <br />