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o •• ..-°4"� . <br /> C'" SAN JOAQUIN COU► t <br /> ' .. .. <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> -_ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> ��FORS <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 1 a S Date: <br /> Address: u k) F" m On I City: �O C4< t_v Zip Code: 952- 0-3 <br /> S203 <br /> Owner/Operator: v `Q h s ^� Telephone: 6 Yq 1 Q <br /> Program Element: I ' Program Record: n ,D 5 __�L(0_0 Inspection Type: <br /> SB180 Posted ",/,Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS ANDeORRECTIVE ACTION <br /> s <br /> U i0 ohs <br /> Item/Location Temperature Item/Location ; Temperature <br /> brawer_5 w X11P <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: aof Chlorine: ppm Heat: of <br /> Exp.Date: Ware shing Sin : of Ouat.Amm.: ')-00 ppm Other: of <br /> Received By/Title: -i.C.Y <br /> EH Specialist: Phone: �S r-t p/7 <br /> Time in: Time Out: � 060Pages of <br /> b 5 <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />