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SAN JOAQUIN COUP ' <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ = 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> c°�li oRa;P Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: P � Date: _ U._J <br /> Address: '-) ,3D <br /> 3 / rru City: `S�C Zip Code: l+ <br /> Owner/Operator: LI Telephone: <br /> Program Element: Program Record: PA 06,3,> Inspection Type: <br /> SB180 Posted Yes ❑ Rermit Posted ❑Yes c) Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS .. <br /> dX L6 Y <br /> aE C ,c <br /> 4eo-j- 71 YZ LO -e <br /> r r t- n <br /> y <br /> 2.j <br /> -�Ilf r `,�, b 4 <br /> ez 0 , r r (/'7 dot <br /> `rte under Wq r l I-e4,,oLs <br /> r 3 APO r, t- <br /> Ctemlt ocationTempera re Tem ra <br /> "j-w <br /> R GZ1J/ <� <br /> —- <br /> god Safety Certificatio7tand <br /> acility Hot Water Temperature Warewashing <br /> Name: Sink: of Chlorine: PPM 'Heat: of <br /> Exp.Date: ewashing Sink: of Quat.Amm.: ppm !Other: of <br /> Received By/Title: <br /> EH Specialist: /1 Phone: <br /> g�53`22/7 <br /> Time in: Time Out: Page of , <br /> EHD 16-24 (21 pg) 413/13 FOOD PROGRAM OIR CONTINUATION <br />