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�O.P4 .CQG SAN JOAQUIN COUP ' <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • c9�1KOR`';P• Telephone:(209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 1 (31z r-_U c s. Date: 7 -3 c 7 <br /> Address: ,Lc-) k Qdl City: lac] _ Zip Code: �S Z <br /> Owner/Operator: +,Z Cccr'(O Telephone: <br /> Program Element: /625- Program Record: (/ Inspection Type: <br /> S8180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 1 , nh e� r cc,ndg ` r s7 e- —PY - <br /> reju'.I 1/ O C1l (n hSlock%)Q- 'e -' <br /> g A I' <br /> f S o rve.- dnwrs <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm other: of <br /> Received By/Title: �� t•f✓ <br /> EH Specialist: d I Phone: c `(os _3v y S <br /> Time in: C7 Time Out: 3 ; rO Page tof <br /> r <br /> EHD 16-24 (2n°pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />