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SAN JOAQUIN COUP <br /> '+ ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax:(209) 464-0138 Web:www.s'gov.org/ehd <br /> 4��FOR�a <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: -q <br /> Address: /-S 8 Gi!G n K City Zip Code: 9S'?4( <br /> Owner/Operator: 6 n Telephone: <br /> Program Element: r L Program Record: S /) y Inspection Type: r <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> (I) Lin _-n Clctin; 4hrc. d. <br /> lush, on vans: LJ��J )� n- ccrr <br /> 3 room o S e �ro / <br /> . n <br /> cse I a I/ on S fis ; n <br /> n j 4 a it 610 f-' cul V C1 <br /> Gve, r 4a C/ <br /> SI& 0c,tI �er C+ n I r; r <br /> k I , I I ,Z ciaer c p iSj2pnSerJ !; <br /> 00eA # A I II <br /> r' 1 iG i f <br /> F. e C fe/ o <br /> rcjl C4 C I/1't Ile b5f tMV6 !icr ¢c <br /> Pc 162q 4,3 <br /> 1l' eDeem - C been a; 1/ <br /> pp Item/Location Temper2ture Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: /L c of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: r� of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: [7 5� Time Out: 6' I Page of <br /> EHD 16-24 (2nd pg) 4/3/1_31 FOOD PROGRAM OIR CONTINUATION <br />