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SAN JOAQUIN COUNT`. <br /> W . X <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> c.., P• Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> 4Ll FORA` <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: �- RL' 1A U Date: <br /> Address: Co Pr i !City: �. Zip Code: 1_0 <br /> Owner/Operator: }�� C1n t •+Ct rte Telephone: <br /> Program Element• I (n Program Reecord: T��� � `� _+09— Inspection Type: -�-1 <br /> B180 Posted Yes No Permit Posted es No Re-Inspection on or After: <br /> jk OBSERVATIONS AND CORRECTIVE ACTIONS <br /> F�,�iC.uS h 'jCA, 1 U <br /> Dtpss -eirm�fi 2olq <br /> Item/Location Temperature Item/Location Temperature <br /> -------- �.— ........... .....---------- <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: PPM Other: of <br /> Receivey/Tit <br /> " ~l .ai / <br /> EH Spe i st: Phone: /2_0P <br /> ime in: Time Out: i•-l_ • Page of <br /> EHD 16-24 (20°pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />