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►-ve, h <br /> SAN JOAQUIN COUviTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> •.. Y iP• Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.s'gov.org/ehd <br /> 4CjFo.�ia <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: „ t ---z t-- Date: tj <br /> Address: S City: Zip Code: <br /> cg <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: 0 Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> r <br /> IKO L+ <br /> rp w <br /> C <br /> 2D <br /> -JA 9 o co <br /> S S C1- <br /> e <br /> i 1 <br /> �o r �d <br /> r <br /> I r <br /> w <br /> " l <br /> it b r <br /> IS <br /> ItemlLocation Temperature Item 1 Locatio Temperature <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 /> Received By/Title: r � L-ems- -- <br /> EH Specialist: Phone: C+.� _ ^'-- <br /> Time in: Time Out: II �S Page of <br /> FOOD PROGRAM OIR CONTINUATION <br /> EHD 16-24 (2^^pg) 4/3113 <br />