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SAN JOAQUIN COUO <br /> a•'�a•Fq� <br /> a y� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 l <br /> �4crFua�';p. Telephone:(209) 468-3420 Fax: 14—(209)464-0138 Web:www.sogov.org/ehd — <br /> ems'.321b <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: m;� c •I �� Date: I — 1 ' _ <br /> Address: `2-0 1 ^ f7 City: \ Zip Code: q 5 . <br /> Owner/Operator: C C„ 1��X•�. Telephone: <br /> Program Element: 1�o( Pr gram Record: �,) Inspection Type: \ <br /> 8180 Posted KYes D No Permit Posted ❑Yes ❑ No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> �'A-NAd <br /> emperature Item/Location Temperature <br /> - 3 <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: oChlorine: Heat: <br /> F _ ppm `F <br /> rewashing S <br /> Exp.Date: Waink: \ eF Ouat.Amm.: L ppm other: -f <br /> Received By/Title: <br /> EH Specialist: --`, )� �1 Phone: \•,' 6 d _� 3� <br /> Time in: 1 Time Out: V I I• Page gf <br /> EHD 1624(2-pg) 41313 FOOD PROGRAM OF CONTINUATION <br />