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oPaulN' c SAN JOAQUIN COUO <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sl4ov.orq/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: !, I Date: _ <br /> Address: I ` ` City: �`r ` Zip Code: <br /> a ' C 7 G <br /> �� w C% <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> SB180 Posted es i No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIQ <br /> <.. <br /> I (A <br /> Io �� �> r % rC lk,-<<+, ., � ; mac:-,-�'' <br /> , O'> Sof 12 Cr l; l� /r 3. <br /> Rt I & ( 2 We )!J , <br /> lb Li c, 3 C c..y) o S I j S r 4 c; ; n <br /> q.! 0r 0 b c 4 1220 i 4 2 <br /> k%ec jo <br /> �Ui.1 U.'1 S � •. <br /> Item/Location Temperature Item ca.n Temperatures <br /> — ---2222-- <br /> rI' <br /> I <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Na—me—: ­ <br /> 7 <br /> N ..7._-- <br /> Hand Sink: i of Chlorine: ppm Heat: of <br /> U / •� <br /> Exp.Oat Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: / <br /> Phone: �C - 7 11E f' <br /> Time in: Time Out: Page of <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />