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SAN .10AQUIN CO TY <br /> i° Cp <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �q.., a.,.�;�P Telephone:{209) 468-3420 Fax:{209) 464-0138 Web:www.siclov.org/ehd <br /> < <br /> < F o>x <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: �} -7 Date: t <br /> Address: 1 j City: �,r Zip Code: <br /> Owner/Operator: 1 Y Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVA ICSNS AND CORRECTIVE ACTIONS ` <br /> a2 ti^Ul�It. --K' L C4.-,wVvJ <br /> ,vua,—d o ,t- 11 PI`K4W10-11V1h kWWlIff <br /> wqc 4 j- r� - <br /> M d G A-Vv,6vd - <br /> -PA ✓�'�vU— o f - ub <br /> J� tkd _ _ -- <br /> 317 <br /> - .......... <br /> Item/Location i Temperature j Items Location Temperature_ <br /> a ✓tU �lln,v vU ��UAL V <br /> cc�c( —uGlF - 3�iE <br /> h c -3 9 <br /> L - r1 ✓w�' �� 3 " <br /> Facility Hot Water Temperature' 1Narewashing <br /> Name: Hand Sink: F Chlorine: Ppm Heat: of <br /> Exp.Date: �1 arewashing Sink: of Quat.Amm.: ppm Other: of <br /> I— t <br /> Received By,Title: <br /> EH Specialist: Phone: <br /> Time in: Time Out: j Q J�I Page f <br /> EHD 16-24 (2n1 pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />