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SAN JOAQUIN COON' <br /> :< <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> to: <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax: (209) 464-0138 Web:www.siQov.orq/ehd <br /> �/FORIN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: - UX G ,7 j Date: <br /> Address: 'L (' II City: Zip Code: <br /> Owner/Operator: J ��V C C Telephone: <br /> Program Element: (/ /e Program Record: 0 ( Z Inspection Type: <br /> SB180 Posted Yes No Permit Posted es NoRe-Inspection on or After: vU/ <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> � � r� - k a ✓f-� c h <br /> l <br /> IO JY vt IGC%got <br /> tmCc✓c� c t1 l�cL r� �rGu <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> .-.---- --— <br /> Name: Hand Sink: �� of Chlorine: ppm Heat: F <br /> Exp. Date: Warewash;ng Sink: /,c,)-0 'F Quat.Amm.: ppm ther: 'F <br /> Received By/Title:x �� f <br /> EH Specialist: ' /� l � Phone: <br /> Time in: Time Out: Page-LofL <br /> EHD 16-24 (211 pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />