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°4"`"' <br /> SAN JOAQUIN COUNT) <br /> �¢�.coG <br /> .y� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �q•.,, �;�P Telephone: (209) 468-3420 Fax: (209)464-0138 Web:wv✓w.sigov.orq/ehd <br /> �IFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: i Cw ? - C l Date: <br /> Address: C' Q� O� J+ City: Zip Code: a S`� O <br /> OwnerlOperator: c'(V i� CA� J Telephone: 3b - ` b-1 <br /> Program Element: , Program Record: v�1_j Z 7ZF Inspection Type: ;7,r ✓" <br /> SB180 Posted Yes ❑ Permit Posted Yes F; I Re-Inspection on or After: \���v <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> \ < <br /> AveS iv a <br /> s i 4-3d- <br /> r a - e <br /> Item/Location Temperature Item I LocationTemperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sin-k':- � aF Chlorine: ppm 'Heat: F_. <br /> Exp.Date: Warewashing Sink: 1 ZZ of uat.Amm.: ppm !Other: of <br /> Received By/Title: <br /> H Specialist: - Phone: 'A b (D <br /> Time in: t Time Out: —�-^ Page, of <br /> • �-C_J <br /> EHD 1624 (2nd pg) 413/13 FOOD PROGRAM OIR CONTINUATION <br />