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SAN JOAQUIN COUNT" <br /> � •.OG <br /> Q: <br /> :z <br /> ENVIRONMENTAL HEALTH DEPmRTMENT <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 j5 p•R� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 11C hL ' Date: I�- <br /> Address: t r' C&4 City: may-,. �n Zip Code: /1- 1f'� <br /> Owner/Operator: Fp Lo op �1 Telephone: �'lu+ I � <br /> Program Element: } Z� Program Record: T, �p-G Inspection Type: <br /> V�!077P_Osted [IYes [IPermit Posted 1 I'- C Yes ❑`,1U Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 1 c�1a-fitc rC1S � b 2�C.9 1 , <br /> ccm �Vc <br /> ii cc i 0 C-/G <br /> S - <br /> Item/Location Temperature Item I Location Temperature <br /> lad' i✓1 r - I`'� <br /> Food Safety Certification s Facility Hot Water Temperature Warewashing <br /> Name: (Hand Sink: of iChlorine: ppm Heat: °F <br /> Exp.Date: �arewashing Sink: -F Quat.Amm.: ppm Other: of <br /> Received By/Tile 1 11f <br /> EH Specialist: �1 Phone: �} •_ �ere) 46 <br /> Time in: 1 V, Q:Z Time Out: I - VV U.•1 `1 Page (of ' <br /> EHD 16-24 (2ntl pg) 4/3113 FOOD PROGRAM OR CONTINUATION <br />