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SAN JOAQUIN COLIN <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • c4.. -:a`P• Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.s*gov.org/ehd <br /> %FOFt <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 7A0,2",2 Date: �A _ci _ I <br /> Address: ,2.- G�,� City: Zip Code: S <br /> VV i <br /> Owner/Operator: � Telephone: <br /> Program Element: 1 lJ t—t Program Record: \ 1 ?j OZ Inspection Type: <br /> IS 8180 Posted Yes ❑ Permit Posted es ❑I Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 0 C4 k Cot <br /> CA <br /> I p <br /> - 03 <br /> e e� <br /> CA_ - <br /> - �' 4e S�\ <br /> '�s C <br /> Item/Location Temperature:'. Terrperatur <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: �ZC of Chlorine: \ ' ppm Heat: oF <br /> Exp.Date: arewashing Sink: 1 J�7, �.� of Quat.Amm.: ppm Other: of <br /> Received By/Title OV <br /> EH Specialist: Phone: <br /> Time in: 1 Time Out: G J Page�9f 2 <br /> EHD 16-24 (2^'pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br /> JO �l <br />