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o � <br /> P°"�" SAN JOAQUIN COUP <br /> � .......... <br /> � •.OG <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 /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: h "jj ' _ ,�� �� Date: / . /"Y-'1y <br /> Address: f V 1iry 1 City: Zip Code: 17 Z) ,` <br /> Owner/Operator: Telephone: �I <br /> Program Element: 16Program Record: Inspection Type:2 U - �d"� - r.-uZ— <br /> SB180 Posted /"Yes No Permit Posted y0'es C No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> SfmmCL J S PC 1 -eh J�% R _-tmpwi.q6te N .f-a/���• <br /> Item/Location Temperature Item/Location Temperature <br /> firma <br /> 1_1M1Z Z <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: S�, ppm Heat: of <br /> C. �` i c. j t c7 `9 s w-= - <br /> Exp. Date: -2- _Z( Warewashing Sink: j 2,5— <br /> of Ouat. Amm.: ppm Other: of <br /> Received By/Title: w <br /> o I <br /> EH Specialist: Phone: �� � L,� <br /> Time in: Z t� Time Out: �' �- PageZofZ <br /> =HD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />