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PQ"'" SAN JOAQUIN COUOY <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.sagov.org/ehd <br /> 9��FORN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: t✓ r Date: <br /> Address: V 1 e k- V-N- City: G�� Zip Code: <br /> Owner/Operator: 1 Telephone: <br /> Program Element: , Ly /,� Program Record: I „ Z��r / Inspection Type: �� <br /> SB180 Posted Yes n No Permit Posted - Yes ' No "� Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> C4 t <br /> M-e K — - <br /> 2 - I0 <br /> vl r <br /> (AA VV44, —W1 <br /> i l <br /> Item/Location Temperature Item/Location Temperature <br /> i1114' /y% v if G l co E-c 3 cl f <br /> " 1 — r-- <br /> _ <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: °F Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: 'F Quat. Amm.: ppm Other: of <br /> Received By/Title:A, <br /> EH Specialist: ✓�Z Phone: <br /> Time in: Time Out: ( Page��f <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />