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�OP4� ' SAN JOAQUIN COUNT-- <br /> .Z� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> cq.,jTelephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> � ii <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: d f'4\04'1 S /V 0HQLy—AL1JC_,(_f-- Date: _/S-/ <br /> Address: ( O/s- r'v11iY1 I City: ` i_ Zip Code: g s 2�G+ <br /> Owner/Operator: O r� N c J / Telephone: 297- <br /> 7 /7 0 <br /> Program Element: 1110/5- <br /> b/5- Program ec d: Inspection Type: UL/" _ <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: 7 <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Ino¢- mac!-er- ak+ r'( 1' 04-7'h Is <br /> W +--e 20 Lam. 2 d <br /> Item/Location Temperature Item!Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: 7L( of Chlorine: ppm Heat: of <br /> Exp.Date: arewashing Sink: ( 7 / 'F Quat.Amm.: Ppm Other: "F <br /> Received By/Title: <br /> EH Specialist: Phone: Q �, <br /> c <br /> Time in: ��-s Time Out: 2 r Page,Zof1 <br /> EHD 16-24 (2"d pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />