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oPaa"' SAN JOAQUIN COUNT <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> cq.. iP Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.slgov.org/ehd <br /> L�FORt� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: + / 4` Date: <br /> Address: 12 I h City: r Zip Code: 9S 3 /� <br /> Owner/Operator: U In�N ` Telephone: (- 9�G q <br /> r - rf <br /> Program Element: �/ �, Program Record: R�C+b �O y y Inspection Type: ( _ <br /> SB180 Posted Yes No Permit Posted Yes - No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> U _ ,� �+ ch,d J Cerci0 1 'Ic+ r S . nK <br /> I 3 [ r ro v✓f <br /> EQU; .4 M re 37a+nLJ/14 <br /> O Y\C uV2 ot <br /> i r r C/ �� C, Cc f rnl <br /> Item/Location Temperature Item/Location Temperature <br /> �JL V'i i/ �v, J Il /t n JL -rr� <br /> W Q 1 <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: dpi fJ tt rI)N n +c Hand Sink: o f Chlorine: ppm Heat: 'F <br /> ! , �i r <br /> Exp.Date: Warewashing Sink: of 11 Quat.Amm. PPM m Other: of <br /> Received By/Title: <br /> r w <br /> EH Specialist: Phone: 3/� <br /> Time in: , 1 o Time Out: Page of <br /> W�l <br /> EHD 16-24 (2n°pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />