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SAN .JOAOUIN COUP <br /> �O. .CGG <br /> (0: < X <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �q.. .�;�P• Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sugov.org/ehd <br /> �/FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: felm-mi- um+or u Date: 1 ��1 14 <br /> Address: 1,505 rt- nnCity: � .�r Zip Code: qc�ao+- <br /> Owner/Operator: S� 1 Q m I S I Telephone: <br /> Program Element: i ko C.7 Prog1rhm Record: R O`(o C6!_U Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes C' No 1IC�� Re-Inspection on or After: <br /> �1 _ <br /> OBSERVATIONS AND d6RRE6TIVE ACTIONS ,= <br /> w¢eA- - C, cA s . <br /> *A- vrgellp- Co- JAM has a VON <br /> w e e.V- . <br /> Item/Location Temperature Item I Location Temperature <br /> N4U11- 10 C(rdid ' <br /> r V M tA' �.Imty I <br /> F d S #ety,Certification Facility Hot water Temperature Warewashing <br /> Name: Hand Sink: "LSU of Chlorine: Ppm Heat: of <br /> Exp.Date: arewashing Sink: I Z U of Ouat.Amm.: PPM Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: -OCA T�t �b_�4 <br /> Time in: w:-.14 Time Out: 1 U: KAPage2of'Z <br /> EHD 16-24 (2nd pg) 4/3/13 1 FOOD PROGRAM OIR CONTINUATION <br />