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SAN JOAQUIN COL Y <br /> N: :t <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sogov.org/ehd <br /> LrpoaN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: _ <br /> Address: 7f� .� City: Zip Code: <br /> G"VL't/YYL(/L jn <br /> Owner/Operator: ,+� ..Z I Telephone: <br /> Program Element: /� 1 Program Record: P—� Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Ij <br /> ` rrGti ti' 12 <br /> f � <br /> �c <br /> ' j W(a' <br /> r <br /> Item/Location Temperature Item/Location i Temperature <br /> l �Llr Y iV✓ V L' L��Y � � �% '� .'W ' -i,�.}r l•i V J- -e( �- �_ __. _..__ _., _ r �_;. __ <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: `` f r Hand Sink: `F Chlorine: m Heat: 'F <br /> Pp <br /> Exp.Date: 2'; l • ` Warewashing Sink: 'F Ouat.Amm.: Ppm Other: 'F <br /> Received By/Title: , <br /> EH Specialist: 4 Phone: <br /> Time in: Time Out: Page)of <br /> =HD 16-24 (2n'pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />