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SAN JOAQUIN COUN' <br /> .A ENVIRONMENTAL HEALTH DEF-HRTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.orq/ehd <br /> �/Foal <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: r Date: Z <br /> Address: 20 W KQ r i grKrji Li., City: Zip Code: 95 a d <br /> Owner/Operator: QVVXC'Y— f <br /> � l G Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> f 003 aZ._ C' c�Ir <br /> 6180 Posted ❑Yes ❑ Permit Posted ❑Yes ❑ I Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Fsc A Q-_311 "K*: h=�- s �' <br /> 1-1 <br /> (Nz.a %. lq �v\ 2-1 (- , <br /> WCA-fer- ep,+er-- 56, , <br /> OL L <br /> 1 a d 4& acm 1 <br /> re ovN Q c I �ed of- "a r- res/0-ttsd . <br /> cam;I le _ <br /> 0.� ^ <br /> e� S OD - -- <br /> Item/Location Temperature <br /> - - — <br /> ,Food Safety Certification _ Facility Mot Water Temperature �- Warewashing <br /> Name: _. ink: �- of l'Chlorine: ppm 1keat <br /> Hand S of <br /> Exp. Date: I Warewashing Sink: F uat.Amm.: ppm Other: F <br /> Received By/Title: <br /> EM Specialist: f`�, _1_ Phone: <br /> Time in: 11 'da Time Out: •� Page�of <br /> EHD 16-24 (2n°pg) 413,13 V —�C/ FOOD PROGRAM OIR CONTINUATION <br />