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SAN JOAQUIN COU Y <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.segov.org/ehd <br /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 71 •_a Date: Z / <br /> Address: 'L. r City: Zip Code: <br /> Owner/Operator: l C,/„ -14 &A , <br /> 1 ,, t nor <br /> �,� Telephone: Z -7(f <br /> � / / <br /> Program Element: Program Record: Inspection Type: Y <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: I <br /> OBSERVATIONS AND CORRECTIVE ACTIONS l <br /> In ` <br /> yr <br /> AM,- wt*h On 0, 1 lot tat <br /> [ cx' <br /> eLocation Temperature Item/Location Temperature <br /> ct' - � <br /> ,OX r3 <br /> Md <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: F <br /> Exp.Date: 11 Warewashing Sink: 'F Quat.Amm.: ppm Other: 'F <br /> Received By/Tit <br /> EH Specialist: Phone: S <br /> Time in: Time Out: t Page-iof <br /> EHD 16-24 (2^d pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />