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SAN JOAQUIN COUN <br /> � •.OG <br /> : � ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sogov.org/ehd <br /> ��FORiN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: /�/�y� Date: <br /> A� / <br /> Address: r City: Leg �� Zip Code: <br /> Owner/Operator: (/ J/ j 6�V l! 4- 51- � � e l /`—� Telephone: 777 <br /> r `•- 1 <br /> Vv <br /> Program Element: Program Rec rd: �� Inspection Type: ��✓ G17G' <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> h",f 114 411f <br /> MA) rt, a fV <br /> S �eov vt / o►� <br /> dr. /Ud n <br /> Ott �qqWGA Cpr-.- <br /> I'm <br /> � <br /> r7paIst 0 U H `a Cl`g <br /> [ n C �' Yl <br /> v1 all <br /> X�- 0 yi'14 ro-1-11I <br /> l � . <br /> Item/Location Temperature Item/Location '' Temperature <br /> v I'tt' <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Ouat.Amm.: ppm Other: OF <br /> Received By/Title <br /> EH Specialist: yw V-t s <br /> Phone: /.f_ <br /> Time in: �) Time Out: CJ's Page oV <br /> EHD 16-24 (2nd pg) 4/3/113 FOOD PROGRAM OIR CONTINUATION <br />