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Paul" SAN JOAQUIN COUP' <br /> 4 `a ENVIRONMENTAL HEALTH DEPARTMENT <br /> N: X <br /> --_ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �q..,, •.�;;P Telephone: (209) 468-3420 Fax:(209)464-0138 Web:www.sigov.or /gehd <br /> �IFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: q r) Ice, �/n VA Date: IIS S <br /> Address: �G)C� �r City: -fes U,� Zip Code: q.5 Z` <br /> Owner/Operator: U 0 I 1 S1 Telephone: Q 14-`�,-Iw� ) <br /> C' 1 <br /> Program Element: SPProgr Record:s 00 :3- 75-f" Inspection Type: aI, u 11z1-hm <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: ._=-- <br /> OBSERVATIONS AND CORRECTIVE ACTIONS. <br /> U N-C) UTA <br /> U CA 5 --- <br /> ` iariLc . t'empet _'!..._ 3rt t:ocatwnxy, <br /> �etature <br /> `` Safey C > ifltlon t acillty Hot'Water Temperature - 1Narewashing �` :; � ' <br /> Name: Hand Sink: - of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: �� fi►t <br /> EH Specialist: Phone: —A Ifo� Iq <br /> Time in: Time Out: Ci <br /> Page (of <br /> EHD 16-24 (2`"dipgg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />