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aPeglN• e <br /> ..00 SAN JOAQUIN COUNT <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sioov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: �N •71 � �i✓ Date: 3 L <br /> Address: 12-01 <br /> � � city: C !�� Zip Code: <br /> Owner/Operator:(/ Telephone: S 4� _6Z3 <br /> Program Element: Program Record: Inspection <br /> c — <br /> �K <br /> SB180 Posted Yes " No Permit Posted ❑Yes g No Pb-inspettion on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> f <br /> c d <br /> -:� uc&Z4 And llev/ 0r N /rlle�"- W, VNfb n <br /> C rlty <br /> ;D10Mf 6&t It , <br /> Item/Loc ation Temperature Item/Location Temperature Item/Location Temperature <br /> i <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> tJame: Hand Sink: of iChlorine: ppm Heat: of <br /> Exp.Date: arewashing Sink: <br /> of Quat.Amm.: ppm Other: of <br /> i <br /> E:eceived By I Title: <br /> ialist: Phone:Time Out: 1 Page of <br /> EHD 16-23 (21°pg) 11/06108 FOOD OIR CONTINUATION <br />