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SAN JOAQUIN COUi- <br /> z� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • c... �p• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.siQov.orp/ehd <br /> 4Li FORS <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: C' b ? ci r Date: Cf <br /> Address: U - S b City: Tr_Ci Zip Code: <br /> Owner/Operator: J / Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> CW <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> l r y3 F G;n �c,; 4 o <br /> be o-,) 4 r a ,4_ 4.du <br /> p r U i, at SG I(3. GC , C/CKS <br /> A .S'� !1K . <br /> 3 ws 4 i2er 0 n Sh, n Re M e y e o 14 <br /> 4 Ches f I e r ). d (—re altgee <br /> I h. <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: N Sink: of Chlorine: ppm Heat: 'F <br /> j4 <br /> /o. r✓1 _ -- <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: j/6 <br /> Time in: I v r� Time Out: Page of <br /> J _? 2. <br /> EHD 16-24 (2nd pg) 4/3113 FOOD PROGRAM OR CONTINUATION <br />