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SAN JOAQUIN COU. f <br /> .y� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> oq.• ;c Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.s'gov.org/ehd <br /> Cii=iiRi•� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: (p ZOO `tea c4- c- City: ion Zip Code: <br /> Owner/Operator: AAA A Telephone: (IS 12_ $ j 73 <br /> Program Element: 1 Z rogram Record: (� I �-� I Inspection Type. oto rL�L <br /> 1§9-18- <br /> 0 Posted ' Yes F Rermit Posted 1 Yes ❑( Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> <e r Pr v-1 <br /> G+_X-b r — an <br /> v r� l.;t an <br /> Y e,--1 <br /> Q be� 1 1' <br /> rneAA.414�in <br /> co'j Of <br /> 4�1j14- cLwy, 6 r <br /> ki- <br /> r *% n n b <br /> till ze r rnLm Y- <br /> LA <br /> rs 5 <br /> Item/Location Temperature Item/Location ; Temperature <br /> l ry'e- <br /> _. <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> -.,,- a... ... . __ .. <br /> Name: hCA 2jAjnYi �f1 Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: arewashing Sink: of Quat.Amm.: ppm Other: of <br /> ZZ)0 <br /> Received By/Title: <br /> EH Specialist: Q , `, w1 _ _v�_ �� J Phone: <br /> - - IQJ <br /> �C <br /> Time in: ` ; I G Time Out: D5 Page, of <br /> EHD 16-24 (2n°pg) 4/3/1.3) FOOD PROGRAM OIR CONTINUATION <br />