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SAN JOAQUIN COU- Y <br /> 4 .za ENVIRONMENTAL HEALTH DEPARTMENT <br /> - _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.or /q ehd <br /> <<FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: sh <br /> Address: V M K vii Zip Code: <br /> Owner/Operator: t Telephone: <br /> Program Element: i Program Record: U S�Le Inspection Type:n <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After:, V V <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> --.._ d <br /> V1kV1A 4A <br /> -- — - <br /> -�G�v <br /> ?14 <br /> --W <br /> r <br /> -N, = 31 <br /> 0/ - A9 Irjjft - <br /> w _ - -- <br /> ....__ ________________.._--_.-.--.- <br /> — X O p <br /> ..Q <br /> mow► ��� •-_ 3 :,�-�t.►�.� <br /> tem/Location e :a, Cats - <br /> - 3SF 33F <br /> �ay� Ck � 0m� 3 S f ail mlw clef t a(/i 1 j 3 <br /> Food Safety Ce i ication R- c q , ,e, temperatureU, „`liing x, N <br /> Name: Hand Sink: of Chlorine: ppm Heat: `F <br /> Exp.Date: Warewashing Sink: 'F Quat.Amm.: ppm Other: 'F <br /> Received By/Title: Z <br /> on <br /> EH Specialist: Phone: IL —MI <br /> ime in: "01Time Out: Page of <br /> EHD 16-24 (2nd pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />