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aQ�1H SAN .JOAQUIN COL Y <br /> �.• •.pG <br /> 4 ENVIRONMENTAL HEALTH DEPARTMENT <br /> - 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �4•..:- ..�;;P Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> LlFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: �• c k r /t ._L�m Date: _2 <br /> Address: 6 /� _ Cr/� �-p a city: 5���n Zip Code: <br /> Owner/Operator: I �t ; n 1` 0-2 - <br /> .2 - ,p ' Telephone: <br /> Program Element: 4 Program R ord: P,2 953 G9 O Inspection Type: V �c <br /> SB180 Posted Kes No Permit Posted Yes -)(No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> --................_.....__ �'.�-�-- r) �t 13 a -7 R X- 5 2 <br /> ---- - _ --. —�- ---- <br /> YY �s n a4 c n w 1-U c.(..P__, -__ �V'e- c.� ayu� co, Ce <br /> b <br /> 7 R7,�' .w .:C. ..r �clf�trllL�,tl� dTf -£x.�y,.Aa._ e ��"` s�emperature Item/.Location .,,,.,�,..},.• Temperatur8. <br /> —--- <br /> Eaod Sa#ety Cert�flcatton :. acilrty Hot Water Temperature Warewashing <br /> u ... . <br /> Name: Hand Sink: `F Chlorine: ppm Heat: `F <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: Ppm Other: of <br /> Received By/Title: <br /> EH Specialist: AA Phone: L 2 O ! <br /> Time in: p: Time Out: p, L Paget of <br /> EHD 16-24 (2nd pg) 413113 O / FOOD PROGRAM OIR CONTINUATION <br />