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SAN JOAQUIN COU, f <br /> �t •.OG <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.s*gov.org/ehd <br /> �!F O•Ra <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: �L �nL CD du � `� ? L� I Date: 'U��/I <br /> Address: City: Zip Code: �2k)6 <br /> Owner/Operator: h 1 I—C-) `ACT-&\ Telephone: Z_491ql�;t <br /> Program Element: t Program Record: � Inspection Type: <br /> SB180 Poste Yes No Permit Posted No Re-Inspection on or After: W 0C <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> TUU 11-N -.s -�Ck":ftl f2OV )u-e_ . W C <br /> w rbdVLE <br /> 2 eo- v'h Ai rn i-t r,o fi an ��e . MGu rikcI n ck <br /> cm i <br /> wX de - <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: arewashing Sink: of IQuat.Amm.: ppm (Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: 2Z61 _ 9 <br /> Time in: ?-, Time Out: " < Pagel of <br /> J 1 <br /> EHD 16-24 (2n,pg) 4'3/13 FOOD PROGRAM OIR CONTINUATION <br />