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a"'" SAN .10AQUIN CC <br /> OIL <br /> ° C. )UK <br /> N: >. X <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • c... ;P• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.s64ov.orq/ehd <br /> 9�rFOtiZ� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 6a 14 9 L' Date: <br /> Address: i '_ City: Zip Code: <br /> Owner/Opera or. 4 G s, �'l Telephone: <br /> Program Element: Program Record: 0 15. Inspection Type' <br /> SB180 Posted Yes n No Permit Posted Yes - No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Lii <br /> r K <br /> (MU <br /> !J <br /> f <br /> (r7 �� <br /> -- r - / cawwvt- <br /> I 1-4 j- I f <br /> 1 <br /> Item/Location Temperature Item/Location Temperature Item 1 Location Temperature <br /> FIA y f r <br /> TP <br /> F god Safety Certificat, n Facility Hot Water t6mperaturle arewashing <br /> Name: r ` Hand Sink: of Chlorine: PPM Heat: 'F <br /> Exp.Date: ( arewashing Si k. � 'F Quat.Amm.: PPM Other: of <br /> Received By/Title. { <br /> EH Specialist: ' Phone: y <br /> fYr <br /> Time in: C9 r S Time Out: Ifs O J PageZo <br /> EHD 16-24 (2^d pg) 4/9/12 FOOD PROGRAM OIR CONTINUATION <br />