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*36 187 <br /> °"�" SAN JOAQUIN COU. t <br /> y� ENVIRONMENTAL HEALTH DEPARTMENT <br /> = 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> �/FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: I Date: v' 0_IS <br /> Address: c1 I I S lti.i r 1-5+01 City: 6t0C'C.-0,_) Zip Code: 16�LQcf <br /> Owner/Operator: 'RO -c ()„ arl -Wi O U'4o — 6Q,rU q Telephone: 1219 _301,77 <br /> Program Element: Program Record: s p� oO rel G1- J6 Inspection Type: C,c nso �l�n <br /> 8180 Posted ❑Yes ❑ R rmit osted ❑Ye/s1 El Re-Inspection on or After: 7 1 <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> LA G B$ <br /> U�L/) yT3ZFl3c5 �U19 �-y�la -- <br /> (,55 cel P OMP r►-w" + ►'o` roe m l (0 3!e FQ� $� -- <br /> Item/Location Temperature � Item I Lo tion ► >�I <br /> a ,��.___ ure <br /> Food Safety Certification Facility Hot Water Temperature Warewashmg <br /> Name: Hand Sink: of Chlorine. PPM Heat: �F <br /> Exp.Date: Warewashing Sink: aF uat.Amm.: PPM Other: of <br /> Received By/Title: /b-` <br /> EH Specialist: Phone: <br /> Time in: Out:Time Page of <br /> <4 8 5b I <br /> EHD 16-24 (2"'pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />