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P41'" c <br /> SAN JOAQUIN COQ_. fY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> . .. r ;P• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.s* ov.orq/ehd <br /> 4c�FORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: roar cJ a Date: a <br /> Address: 2 IDL—0 3 67 rot V1 City: C �,� Zip Code: (3I 5207 <br /> Owner/Operator: 5)1 Telephone: 11 15 I;t_�Q�_0 <br /> Program Element: I (O 2('"r Program Record: n n O ins ,.X Inspection Type: O/'2A. <br /> SB180 Posted Yes No Permit PostedX Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS �� <br /> I w A.-I-e_r )1 o + �ieI4 ..2 r) e L3 11 - I ZO o ._ <br /> Lj <br /> Item/Location Temperature Item/Location Temperature Item/Location Temperature <br /> --- — <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: PPM Heat: of <br /> Exp.Date: WaraWavtrtng Sink: / of Quat.Amm.: PPM Other: of <br /> C!012 <br /> Received By/Title: - n <br /> EH Specialist: Phone: <br /> Time in: :q o Time Out: �0 Page of '9— <br /> EHD 16-24 (2n°pg) 4/9/12 FOOD PROGRAM OIR CONTINUATION <br />