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PQ"I" SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.smgov.org/ehd <br /> �/FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: cldl Af a 2 me t7 <br /> Date/&- <br /> Address: <br /> -ddress: /y 2 City: /�aii4eL Zip Code: S3 6 <br /> Owner/Operator: G OD[e / Telephone: 39. Od <br /> Program Element: 16 D Program Rec rd: O p3 3 Inspection Type: <br /> SB180 Posted C Yes No Permit Posted C Yes XNo Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> )?e 4...,yjj S 21� �l Gr <br /> a - C(10(k.-l-�. ads►�.er-s , <br /> MOr S, k- 13 S'F <br /> Item/Lo cation Temperature Item/Location 'Temperature Item/Location Temperature <br /> d,, <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: 'F. <br /> Exp.Date: Warewashing Sink: 30°r of Quat.Amm.: ppm Other: of <br /> Received By/Title: l/ / 1.; <br /> EH Specialist: Phone: <br /> Time in: '? ; Time Out: . Page of <br /> EHD 16-24 (2^'pg) 11/2109 FOOD PROGRAM OIR CONTINUATION <br />