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SAN JOAQUIN COU I' <br /> z� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • cq.. ��P Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.slgov.org/ehd <br /> �/FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: l3'e>Q <br /> Date: ! �. <br /> Address: 0 rl r � � City: 6+0 'I 11 Zip Code: 5�� <br /> Owner/Operator: 1_ n lo; D+ i t Telephone: to-7_ 4 1 <br /> Program Element: 1�Z3 Program Record: (to 50 S 319 Inspection Type: <br /> SB180 Posted, Yes No Permit Posted)(Yes I No Re-inspection on or After: <br /> / OBSERVATIONS AND CORRECTIVE ACTIONS <br /> r► q-z -1 Cf W Co rr•t c- - <br /> t- W <br /> rro c14 Ae _ clKYLao-aA-elln <br /> W a r-1- I <br /> r r L <br /> Item/Location ( Temperature Item I Location Temperature <br /> ----- .._— -------------- <br /> I <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> - -- -- -- . : .__....--- - ---— - -----_—- -- - _. .._._.._ ........... <br /> Name: Hand Sink: of Chlorine: ppm Heat: 'F <br /> Exp. Date: Warewashing Sink: of Ouat.Amm.: ppm Other: °F <br /> Received By/Title: <br /> EH Specialist:— Phone: <br /> Phone: 0153 <br /> ,1L p 1 <br /> Time in: ,/ ;` 51 Time Out: I , 140 O / Page I of <br /> EHD 16-24 (2n'pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />