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0.0 " SAN JOAQUIN COUK <br /> 4 X ENVIRONMENTAL HEALTH DEPARTMENT <br /> - = 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �Q•...-....�;�P Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> L�F6 <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: u ce Date: �Z- 3/ <br /> Address: A 4 t. kcA GG City: Stpr/1�� tCn (1 Zip Code: k O <br /> Owner/Operator: _ Uh G U ` ,J, � Telephone: "�1 <br /> Program Element: ` '�7U 3 Program Record: I (, c� Inspection Type: /•�„-�S� <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: �l <br /> 0 <br /> OBSERVATIONS'AND-C�C?RRECTIVEAPTlONB; <br /> ---.......................... _.._ -- ._....--...-......................................._...... <br /> -- <br /> l.l <br /> -� U P__ p ftm+r U-F4-per �e_ e 6k- <br /> -- <br /> ro i s i t- I b 3�0 <br /> I <br /> Item/L.ocation Temperature Item/Location Temperature <br /> Facility mperature Warewashing <br /> Food SafetyCertification Facili Hot Water Te <br /> Name: Hand Sink: of Chlorine: ppm Heat: F <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: Ppm (Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: n <br /> Time in: �. Time Out: ;vQ Page iof <br /> EHD 16-24 (2n0 pg) 413113 FOOD PROGRAM OR CONTINUATION <br />