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"°"�" SAN .10AQUIN COUN <br /> .2� ENVIRONMENTAL HEALTH DEPARTMENT <br /> N: Y X <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> �/FORM <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: �'�� �� Date: <br /> Address: n/ C\ City. Zip Code: <br /> Owner/Operator: I_ ( / � I In Telephone: _2�>`_ +2_ <br /> Program Element: 015 Program Record: p Q r � Inspection Type: <br /> 8180 Posted qNes ❑ Permit Posted 1` E Yesl 91 <br /> IG Re-Inspection on or After: <br /> 10'11- <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> lcte, a Fo - n ',-> _ Ec -n t�L <br /> - MPO '(kor n 1 wPaf- co <br /> iC hM C1UM0, CArd V O( -N-M . C .P_C A- -tea <br /> JhL mw�� i �� :S s fih.e. -scm '►11 1c.e � <br /> T\S� aeeOS - v r <br /> car r �_ ho 11rb i MCI)nioih G cc, <br /> CA <br /> ItemlLocation Temperature I Item l Locab Temperature <br /> - ------- --------- <br /> Warewashin <br /> Name: Hand Sink: 100 o f Chlorine: ppm Heat: 'F <br /> Exp. Date: Warewashing Sink: (�G of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: n �� 62i -14-6 <br /> Time in: 1,J Time Out:` 1� J v Page f�� <br /> Z_ <br /> EHD 16-24 (2r0 pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />