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SAN JOAQUIN COU. <br /> X ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ = 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.siaov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 0e, Q�. I[��^ Date: 5-9-15 <br /> Address: q <br /> Q City: _ v � Zip Code: Q% Za Z <br /> Owner/Operator: A-0nu-4j4—U L cam— Telephone: <br /> Program Element: /5 Program Record: Q D 2 Inspection Type: <br /> 6180 Posted Yes ❑ Permit Posted VYes ❑ 1 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> W C�' ki <br /> r <br /> a.ctu n y� ,F <br /> Food Safety Certification Facility Hot Water Temperature <br /> Name: Hand Sink: - �F Chlorine: ppm Heat: 'F <br /> Exp.Date: Ware ashing Sink: ��� 'F Quat.Amm.: ppm ther: of <br /> Received By/Title: 77 <br /> EH Specialist: _ G /�^ Phone: <br /> Time in: © ` Time Out: :y5 Pagi;�Lof 2 <br /> EHD 16-24 (2nd pg) 4'313 FOOD PROGRAM OIR CONTINUATION <br />