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PQu�" SANJOAOUIN COUP <br /> ; <br /> y-� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.slgov.org/ehd <br /> �iFoaa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: J �. - U t r Date: / /3 _ V <br /> Address: L� "f City: Zip Code: <br /> .2 b it — } .+ iqs� 7 6 <br /> Owner/Operator: J Telephone: <br /> 0� � z I 711I���Ui Z_ <br /> Program Element: i Program Record: Inspection Type: <br /> `I v 3� P1j' <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> U � y , U1in -U '-%� GcrreCIt-d ,XC,lyj <br /> 1 c M S n I ; 14Q r C'0 r, <br /> Lo0 c <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> - — <br /> Name: Hand Sink: SOL t_ of Chlorine: PPM Heat: of <br /> Exp.Date: W7rewashing Sink: of Ouat. Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: one: <br /> Time in: Time Out: z Z Page of <br /> EHD 16-24 (2nd pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />