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SAN JOAQUIN CO*y <br /> r9 c°G <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �q.. ;P• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.si4ov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: Z Z � <br /> Address: 6 YKW.4� City: �` Zip Code: <br /> Owner/Operator: V r l Telephone: <br /> Program Element: Program F1 ord: Inspection Type: <br /> SB180 Posted I <br /> Yes -I No Per Poste Yes _1 No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> __ <br /> V-J491h 4-o <br /> Vt� ✓1 - - <br /> L - C h toy7vu- <br /> (y - <br /> S� 0 <br /> M I6l2C <br /> Item/Location Temperature Item/Location Temperature <br /> _.._ ,-- ---- -- <br /> ............. t <br /> 14; n4 V0 <br /> i 1,�V1 �t Vl & c <br /> Food Safety Certification Facility Hot Water Temperature Warewashmg <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> r /�RG(l���c - <br /> Exp.Date: 2 / W ewasring Sink: J of Ouat.Amm.: ppm Other. of <br /> J l <br /> Received By/Title: <br /> EH Specialist: f� Phone: <br /> Time in: '2 1 Time Out: t Page of <br /> EHD 16-24 (20°pig) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />