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Pa�'k SAN JOAQUIN COU. <br /> . <br /> y+ ENVIRONMENTAL HEALTH DEPARTMENT <br /> Yl: X <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sagov.orq/ehd <br /> �IFOft t� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: t. Date: <br /> ddress: L �C City: Zip Code: <br /> Owner/Operator: iTelephone: <br /> Li 105-Z Z <br /> Program Element: 23 Program Record: n 0 t (00--3 <br /> 00 Inspection Type: I <br /> B180 Posted ❑Yes ❑ Permit Posted ❑Yes ❑I Re-Inspection on or After: �� L <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> h l v ,-i-c I <br /> r L"Y1 k-X2 <br /> n r vcpbArLu4- c L_oa <br /> n <br /> e Y-j an <br /> -fug cLy n n be 2 <br /> ril) r l�:-s VLS__ n <br /> Y- 'tot r) l _ d <br /> 16D a-b 2:>V--. C-0 0)c_- r1 -e , L&,- 0 n1-e Y14 <br /> C-0 V-2 r p ,dp_ a U Coy <br /> S <br /> r has <br /> c.� m <br /> — r e_on La r <br /> ttemlLocaGon Temperature Item 1 Locao, Tertaperature <br /> w A Facility Hot Water Temperature Warewashing <br /> -111111 1.. <br /> Name: Hand Sink: of Chlorine: ppm jHeat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: l.� ? Time Out: �� Page- A <br /> EHD 16-24 (2^a pg) 4,3113 FOOD PROGRAM OIR CONTINUATION <br />