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'o.Pa .CaG SAN JOAQUIN COUI- <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 /> �fFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: a-� 1--fi Date: <br /> Address: Ljo y ,, f _F r� f City: 5.� �fj <br /> � - y? Zip Code: <br /> Owner/Operator: IN, l Q f a Y Telephone: &yq_1 q 10 <br /> Program Element: l tj p <br /> fD Program Record: D 5Z (.0C)q q Inspection Type: <br /> B180 Posted l 1 "7Yes ❑ Rermit Posted r ,l Yes ❑ 1 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Item/Location ; Temperature 3' f, a�.� Item 1 Location Temperature <br /> r cz o Le r <br /> Food Safety Certification Facility Hot Water TemperatureWarewashing <br /> Name: Hand Sink: of LChlorine: ppm Heat: of <br /> Exp. Date: arewashing Sink: of at.Amm.: ppm Other: of <br /> Received By/Title: <br /> zkz <br /> EH Specialist: Phone: /� J 5 7 „_� <br /> �J ' <br /> Time in: • `© Time Out: /'l,� Page) <br /> 1 of <br /> EHD 16-24 (2nd pg) 4,13113 FOOD PROGRAM OR CONTINUATION <br />