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SAN JOA0UIN COU i( <br /> X ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> F6aa�P Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.si4ov.orq/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ; �� C� ��L� ZLj�/ Date: <br /> Address: , i Ci . Zip Code: <br /> Owner/Operator: ('_ Telephone: <br /> Program Element: ro r Record: Inspection Type: <br /> SS180 Posted es o Permit Poste Yes No Re-Inspection on or After: <br /> WNW" OBSERVATIONS;AND CORRECTIVE,ACTIONS. <br /> a <br /> _. .._......................._....... --- <br /> xl(jvul -- -�- <br /> X,I( . <br /> UM4AIM JJ G — t+IwWh ► yz �y <br /> wlt'iA I ✓lt <br /> V ` <br /> V <br /> w ...-__ <br /> item/Location Temperature Item/Location ,„ '` Teroperature <br /> V r L= c.� � i <br /> V <br /> Ili�tGUV ^Gtj j k R , l Z) <br /> Food Safety Certification Facility Hat Water Temperature „ Warewashing <br /> .. <br /> Name: Hand Sink: - °F 'Chlorine: Ppm Heat: `F <br /> Exp.Date: arewashing Sink: I -F Ouat.Amm.: Ppm Other: -F <br /> a <br /> Received By/Title Z <br /> EH Specialist: r ? Phone: <br /> Time in: f I Time Out: r] p, Paggof <br /> EHD 16-24 (2nd pg) 4013 CTI! FOOD PROGRAM OIR CONTINUATION <br />