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SAN JOAQUIN COUN <br /> �+ ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ..- ;4• Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.s*gov.org/ehd <br /> qC/j ObW <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 150 19 Date: y_` <br /> Address: 12 o•S .5 ,n^ - .� s City: f,,n/\�` Zip Code: �3 <br /> Owner/Operator: �1 , CjN`-v t�J`'�` <br /> Y\ 1Jv� 1 n 0V\C \ Telephone: 23ct- b`� S� <br /> Program Element: `b-Z�-j Program Record: SO I-:i� Inspection Type: (Ze; <br /> 6180 Posted ❑Yes ❑ Permit Posted ❑Yes ❑1 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> -CSS S C (e i,\5 �& v--\ -�--r.;r✓A t r�� r cu \ v� `( - ► . <br /> Q ' \ <br /> Item/Location } Temperature I- - Item f Location i Temperature <br /> Food Safety Certification Facility Hot Water Temperature ware washing ,z <br /> Name. iHand Sink: 1w- 'F Chlorine: - ppm Heat: °F <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: - \„ Phone: <br /> - <br /> Time in: 1 OD Time Out: `' � Page of <br /> EHD 16-24 (2n°pg) 4.3/13 FOOD PROGRAM OIR CONTINUATION <br />