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SAN JOAQUIN COU* <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.si4ov.org/ehd <br /> �IFo'ea <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: / <br /> Address: Q �� rn city: Zip Code- <br /> Ono <br /> Owner/Operator: cl Telephone: <br /> Program Element: Prog m Record: CM <br /> 2 S Inspection Type: <br /> B180 Posted ❑Yes ❑ Rermit Posted ❑Yes ❑1 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> d-k? <br /> A'y� u Q t <br /> IPA ,f ti <br /> IN OIVh 0'( „",L, <br /> Y Q,wul YLAkI KVLILI v <br /> V <br /> a j �,.P1i� ,-I— 0 . <br /> } <br /> -R 1 b <br /> WI anog <br /> "' <br /> Item/LocationL , II -- _ <br /> tem Location .. ,,. <, Temperature <br /> Food Safety Certification Facility Hot Water Temperature ±j Warewashing <br /> Name: jNand Sink: _ __. <br /> 'F Chlorine: ppm Heat. OF <br /> Exp.Date: arewashing Sink: of 16.uat.Amm.: ppm iOther: of <br /> Received By/Title: Y v A <br /> EH Specialist: Phone: <br /> Timein: f 17 r Time Out: Pag 1 <br /> o <br /> EHD 16-24 (2^°pg) 413113 FOOD PROGRAM OR CONTINUATION <br />