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°"!" SAN .10AQUIN COUN' <br /> �o <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.slgov.orp/ehd <br /> �IFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: dc'l�r-I�c-> Date: 7 r 1&-1-f <br /> Address: 9 20 City: L Zip Code: 9�- <br /> � <br /> Owner/Operator: Telephone: <br /> Program Element: t(o Program Record: .3 2 2 v Inspection Type: <br /> VB_18_0P osted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS 1� <br /> coo c3 L 1A(� <br /> S t cc rI �C]�5 T O rQ Pi,'-qr.A S <br /> 2 / Wvi`VXC'h fiG.r <br /> r <br /> f2( S41 1, «r dr- '%)Q /N <br /> d <br /> (o � �(c1v � r-Qu S C�ca.� c� o►- <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 uat.Amm.: ppm they: of <br /> Received By/Title: <br /> EH Specialist: 1 Phone: qGl( g.-3IN <br /> Time in: /`2 Time Out: I t•�y<_ Page of <br /> EHD 16-24 (2nd pg) 4/3/113 FOOD PROGRAM OIR CONTINUATION <br />