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SAN JOAQUIN COU. f <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • c... :P• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.orp/ehd <br /> 4��FORN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: �� �� r "� , 1 I, i 7 �, (; Date: 11- 1. I <br /> Address: ) City: Zip Code: <br /> 3 v <br /> Owner/Operator: Telephone: D y g <br /> Program Element: Program Record: Inspection Type: U <br /> SB180 Posted v les No Permit Posted es No Re-Inspection on or After: <br /> O EF_,A, QOREC' JV ACTIONtS <br /> F <br /> rP I <br /> LA i ssu A 61 > <br /> dK ri0 o Sx, 6c,r" C I : A 2 cjerg <br /> If Ch 11 � h <br /> da i la l t <br /> a�. C . i <br /> ✓( n ,- Go� <br /> re acrrec � l <br /> Pro v; dc 10 be 15 oh all C <br /> Corrpr 4, <br /> 1 671\ CoS1� <br /> i l• M S• CVrpc G a X U rl <br /> Item/Location Temperature Item/Location Temperature <br /> eA� ---- ----- f13s l% irut AL�l <br /> t I (= Tru e l' r _ 3 6 <br /> p� 5 1CA♦ <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: i rJ 11--nG fvG^ Hand Sink: 'F Chlorine: ppm Heat: of <br /> Exp.Date: I (� Warewashing Sink: 1,21 'F Quat.Amm.: ppm Other: �F <br /> Received By/Title: I <br /> EH Specialist: Phone: <br /> Time in: Time Out: Page of <br /> EHD 16-24 (2n0 pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />