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°Q" " SAN JOAQUIN COUP. <br />�o..coG <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siQov.orq/ehd <br />�i FORS' <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: �,� '} + I <br />Date: <br />Address: 1 <br />1! �� r Lit, <br />City: Zip Code: <br />5 3 7 <br />Owner/Operator: <br />Telephone: <br />Program Element: Program Record: <br />Inspection Type: <br />cca r <br />Posted Yes No Permit Posted Yes No <br />L2 <br />Re -Inspection on or After: <br />EHD 16-24 (21d pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />i <br />(t /i�sinr�+�h <br />( c(rt;c L <br />i r1 i,t)Pc lt: <br />n� , <br />Item/Location <br />Temperature <br />Item / Location <br />Temperature <br />l X ( d r2 -Boon) <br />Food Safety Certification <br />Facility <br />�{ %� ' <br />i <br />Hot Water <br />Temperature <br />Warewashing <br />Name:Hand <br />Sink: i <br />`F <br />Chlorine: <br />ppm <br />Heat: of <br />Exp. Date: I <br />Warewashing Sink:J� <br />of <br />Ouat. Amm.: <br />ppm <br />Other: of <br />Received By / Title: <br />EH Specialist: <br />Phone: <br />c7 <br />Time in: <br />Time Out: <br />fi Page of r <br />EHD 16-24 (21d pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />