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SAN JOAQUIN COUN- <br /> X <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> W <br /> -_ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax:(209) 464-0138 Web:www.segov.org/ehd <br /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: j�i ��- ZS Date: <br /> Address: `C k LA,,`e 4\ City: Zip Code: * <br /> Owner/Operator: ` `nG Telephone: 1 <br /> 36 - 5zy <br /> Program Element: ko Program Record-� b5�3Z$ Inspection Type: <br /> SB180 Posted a No Permit Posted a No Re-Inspection on or After: ►s*1✓� <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> v f UCC hack bpi 1e5. Qe etrz- in L week <br /> tw VL" -kv'� lam Cl 6 OLA CAC- . e2 i!\ l �►.��JC <br /> c a n()r' at y'3' F . (notr to kmr bekc•�.> 41 F. C&-eecf <br /> K1'. <br /> Ge ahn ux� hav'ds Pao, t$ � M <br /> des -b kkI('VN PA ems. C I <br /> +n �v►o-�l po,�a� ca�oF �P- m ,� <br /> vkca Cojet- aackqA av--E to Z vxQlla <br /> & 5 il(\ O e4L aa CeW .5 <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: ° Chlorine: pp Heat: <br /> F m D,�, °F <br /> Exp.Date: Warewashing Sink: °F Quat.Amm.: ppm Other: °F <br /> Received By/Title: (7,6 <br /> EH Specialist: Phone: <br /> Time in: Time Out: Page sof`Z <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />