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oo-qu" SAN JOAQUIN COUN <br /> Q` ?� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax: (209) 464-0138 Web:www.slaov.org/ehd <br /> �%FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: I77-a1 Date: <br /> Address: --') City: Zip Code: <br /> ef <br /> Owner/Operator: / a Telephone: <br /> Program Element:l /, Program Re rd: � Inspection Type: <br /> SB180 Posted a No Permit Posted es No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> q -y2lliifC— •-t h-t <br /> akte <br /> G'n lhe.7,v <br /> kvt <br /> I <br /> "Vell 41f <br /> 5 Flon <br /> S1 n _ <br /> F 01 <br /> Item/Loca 'on Temperature Item/Locatio Temperature <br /> tcH01/ J <br /> Food Safety Certificatio Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp. Date: ar washing Sink: Z of Quat.Amm.: ppm ther: of <br /> 42 <br /> Received By/Title: l <br /> d I ZG <br /> EH Specialist: Phone: <br /> Time in:31 <br /> 6V Time Out: Page'bf <br /> EHD 16-24 (2n1 pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />