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,0°'4 G SAN JOAQUIN COUP <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> L�FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: o u Lq_- Date: <br /> Address: City: St Zip Code: <br /> Owner/Operator: �AaU r-1 Telephone: (P It _ YcvL77 4 _�z re <br /> Program Element: {(pG Program Record: �L�67-} Inspection Type: 1 �� <br /> B180 Posted es No Permit Posted es No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 1 IaC cA W1-� S' vr+ r <br /> deur 1v <br /> cA <br /> 3- 1 s <br /> m/ op Temperature Item/Location Temperature <br /> wol1 14�. <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> _ ..._...... <br /> ----- ------�_.__..---- - <br /> Name: Hand Sink: (11 6 of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Ouat.Amm.: ppm Other: of <br /> Received By/Title: <br /> C "Z G - <br /> EH Specialist: Phone: a _ ��s <br /> Time in: I Time Out: 0 S b Page2of7__ <br /> EHD 16-24 (211 pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />