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SAN JOAQUIN COUI t <br /> Q` y+ ENVIRONMENTAL HEALTH DEPARTMENT <br /> N: x <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �q.. �;P• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.slpov.org/ehd <br /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 1.. - .; Date: > <br /> Address: City: –' t ` Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: a� f <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 1 U+S 4 0 34o-; 2j Oro not Qyu;lpbrcu:r.�C <br /> Item/I ocation —Temperature Item/Location Temperature <br /> T'4C <br /> 7k N I- dovh 4�1 , p l <br /> Food Safety Certification Facility Hot Water Temperature Warewashing a' <br /> Name: r Hand Sink: Chlorine: Heat: <br /> 1 n 4 •1 r 1 Uc_ r °F ppm i , °F <br /> Exp.Date: , arewashing Sink: °F Quat. Amm.: m Other: °F <br /> pP <br /> Received By/Title: <br /> EH Specialist: Phone: /_ y,Y//1 <br /> Time in: - /� Time Out: v0 v Page o�z_ <br /> EHD 16-24 (2'pg) 4/3/13 J FOOD PROGRAM OIR CONTINUATION <br />