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PQu�" SAN JOAQUIN COL Y <br /> N: X <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.segov.org/ehd <br /> �/FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: .Jr_ <br /> Address: Ll O 4- F-r-e m on * City: S�O C4C�Vh Zip Code: :2-d <br /> Owner/Operator: I�OfT O 175 Telephone: 6 y 41-119�D <br /> Program Element: I� Program Record: P (o D Y Inspection Type: <br /> SB180 Poste Yes No Permit Posted VYes No Re-Inspection on or After: <br /> OBSERVATIONS.AND 66RRECTIVE ACTIONS <br /> m& i CS w a u l,5 tJ'1 (�A SY <.t i t - <br /> � <br /> h.oh aG�sor _ �rr b <br /> HV f` /AGO 6 :b <br /> Item/Location Temperature Item/Location I Temperature <br /> 11 o 6 cf e r" Z-56 F° /3 �F <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: �a of Chlorine: ppmHeat: of <br /> Exp.Date: Warewashin Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: _ L_ Phone: _ 4 17 7 <br /> Time in: I O. �GZGrif Time Out: ! I O / Pag�of a <br /> EHD 16-24 (2"l pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />