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SAN JOAQUIN COL <br /> ?, ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> <<FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Char ,L S Date: <br /> Address: G O a u-A-C- AV City: '��•�� Zip Code: 9�3� 9 <br /> Owner/Operator: 5/N Telephone: 573 V s P <br /> Program Element: l b;Li� Program Record: 011�Q S 23 3 3 a Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> 50, <br /> OBSER1lATIONSNU C�RRECTIVE3ACTONS <br /> r <br /> Item/Location t:Temperature Item/Location Temperature <br /> ....._.. --- - -- -- — �------- <br /> I <br /> Food Safety Certification Facility Hot Water Temperature Warewashing - <br /> Name: Hand Sink: °F Chlorine: ppm Heat: `F <br /> Exp.Date: arewashing Sink: of at <br /> Ar►7gi. ppm Other: of <br /> Received By/Title: �J�tt <br /> EH Specialist: Phone: 0- 53- -2Y17 <br /> --- -..__....._....... -- - <br /> ime in: , Time Out: 1 �5 Pagel of <br /> 10 EHD 16-24 (2W pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />