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SAN JOAQUIN COU Y <br /> P •• <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ = 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �;..• ..�;;P Telephone: (209)468-3420 Fax: (209) 464-0138 Web:www.sjgov.org/ehd <br /> ��FpR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Y-..-_e 5 Date: q71 0-1 <br /> Address: r� IA City: Zip Code: 2O <br /> SL <br /> Owner/Operator. Ll/ Telephone: Y/ <br /> Program Element: l� ! ' Program Record: R O Inspection Type: n % <br /> 6180 Posted ❑Yes ❑ Rermit Posted ❑Yes ❑I Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS"A <br /> Item/Location Temperature Item/Location Temperature" <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: 'F (Chlorine: ppm Heat: of <br /> Exp.Date: arewashing Sink: of iQuat.Amm.: ppm ther: of <br /> Received By/Title: <br /> EH Specialist: IrAA Phone: _- ' <br /> Time in: ( � Time Out: Page of I <br /> EHD 16-24 (2^n pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />