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SAN JOAQUIN COUNTY <br /> y� ENVIRONMENTAL HEALTH DEPARTMENT <br /> U7: X <br /> _ - 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> cq ;P Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgog v.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 5 S) ro I juas ; -{ R I Date: - <br /> Address: U0 o NOCity: fir?n%' h Cam Zip Code: QS.2 3 / <br /> Owner/Operator: Telephone: oi/_K,b-113 <br /> Program Element: Program Record: Inspection Type: `7Cl <br /> in <br /> SB18O Posted ❑Yes ❑ No Permit Posted ❑Yes r_ No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 1 ; n K <br /> Wn iA gemoLff 40doLe <br /> AA 141 C Cf fer� (A ;J -j a <br /> ba J Iaryl V te f ima ve C,da <br /> erovida 14 be 15 Lr all 11 c,d no d[.l c4z G1 ; <br /> 1 SC'ry c� i n 2 WPv <br /> ra✓; ch Co vers o r !e lurchCt ndf 6Ott ion <br /> Item/Location / Temperature // toC <br /> Item/Location Temperature /'1hItem//Location Temperature <br /> 7-f C4 AIS n `L)-rfV, 6 <br /> I F <br /> ✓e .cK <br /> u r <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By I Title: u ^(A-.—z <br /> EH Specialist: Phone: 6 <br /> ime in. Time Out: Page of <br /> EHD 16-24(2nd pg) 4/9112 FOOD PROGRAM ORCONTINUATION <br />