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SAN JOAQUIN COL 'Y <br /> X ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • c4.. -.a�P Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.s'gov.org/ehd <br /> �/FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility:rs e-va Date: -16 <br /> Address: ZW r �n J �Q n� I City: 5+o cL.to Zip Code: a �© <br /> Owner/Operator: 61 � C.` Telephone: 2_7 <br /> 2 170 <br /> Program Element: 1 f_� Program Record: P�5 I. Z Inspection Type: <br /> SB180 Posted Yes CCN��o Permit Posted Ives No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> YYtV S i--L k Igo -e Ytc <br /> shAmt l 64,, auctAr rno a n <br /> Y— arl6 wa ren W00-f-r d too - 10?*F <br /> COT <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp. Date: Sink: j % of Quat. Amm.: ppm Other: of <br /> Received By/Title: ; <br /> EH Specialist: ^ C_ L•Phone: Q6" <br /> Time in: .4,0 Time Out: `•^1 :Z C Page�of <br /> EHD 16-24 (2nd pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />