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oPQ�I" SAN JOAQUIN COUNT <br /> �.• goo <br /> ' + ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sjgov.or_q/ehd <br /> <<FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: (7J[, >�flGU I Date: ' <br /> Address: City: 7 A _>-,�( Zip Code: <br /> Owner/Operator: r�►,t///fi�t(� C r�n G� Telephone:342- _G�i� <br /> Program Element: ` �o�V Program Record: co L>o Inspection Type: (c (U�./_n�� <br /> 1 J �"I <br /> S8180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> F OBSERVATIONS AND CORRECTIVE ACTIONS <br /> c c a l n� <br /> ( �_ia►S CO- -�no c h <br /> h -Ivr�s V) uc. - n h' <br /> v,e-R i 1-Fu , 1-ho T4 ar-e- 9Z4_,_ fib e <br /> Wffi -f <br /> -- V + .Pcnq zdu - , )a e cr a vn +c 1\e_ <br /> �,- C cnb uL 171" O F a> u c <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: aF Chlorine: ppm Heat: of <br /> Exp.Date: arewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: r) ,o <br /> Time in: rl . ,�U Time Out: r '—t 1C Page of <br /> � V <br /> EHD 16-24 (2nd pg) 413/13 FOOD PROGRAM OIR CONTINUATION <br />