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SAN JOAOUIN COU Y <br /> Wes 0 <br /> q. „/ y� ENVIRONMENTAL HEALTH DEPARTMENT <br /> - 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> .. - ..•''p Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: F 0- d L- - 41:_tTT 58 q/ ( Date: _ <br /> Address: 0 , GQ U a City: / v L�n Zip Code: � ) _ <br /> Owner/Operator: Y err/•R n{ nq T N` Telephone: Ow 3y- <br /> I h <br /> rO <br /> Program Element: I /�Program Record: P r� y Inspection Type:RV � / <br /> SB180 Posted Yes No Permit Posted Yes I No v Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 1107-c' C J r r-eh IM r nnA4 kA s 2 n p LA 4-e_ n u rM b-e rs - <br /> 6L117 ® r-L !� 388 (Q &s <br /> ti� NU3 ► K, FI 2 <br /> 0- Y, L6_5v yrL r a0 <br /> Item/Location -_ Temperature Item(Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashmg <br /> Name: 4and Sink: �F Chlorine: PPM Heat: F <br /> Exp.Date: arewashing Sink: of Quat.Amm.: PPM Other: -F <br /> Received By/Title: <br /> EH Specialist: Phone: 015 5` <br /> Time in: •7 r-1 Time Out: � Page of <br /> EHD 16-24 (211pg) 4/3/-9:0 <br /> 3-v FOOD PROGRAM OR CONTINUATION <br />