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Po��" SAN JOAQUIN COUR- <br /> •.OG <br /> { ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �q... AP Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.s'gov.org/ehd <br /> �fFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: U I W C X-ecl -A Date: I b/ - <br /> Address: h City: �, y,p„-n Zip Code: <br /> Owner/Operator: �1 v i Ck u n t� �Iv Telephone: `4'I _ (o(a 3G <br /> Program Element: 1 ('VC)r7 Program Record: ., n r_� Inspection Type: y I �n <br /> OUT <br /> B180 Posted ❑Yes ❑ Rermit Posted ❑Yes ❑1 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> lac 11 <br /> CAN 'S hu t USfi <br /> �h s�JI.eS df v�h�c-1,Q <br /> 0 ` SSS Safi a ON- <br /> �- ar YE - ram <br /> Item/Location Temperature Item!Location ,•Temperature <br /> Food Safety,Certification Facility Hot Water Temperature .. Warewashing <br /> --_ <br /> Name: (Hand Sink of Chlorine: ppm .Heat: 'F <br /> Exp.Date: NVarewashing Sink: aF Quat.Amm.: ppm Other: "F <br /> Received By/Title: <br /> EH Specialist: {/ J\ Phone: <br /> _ <br /> Time in: i Time Out: /? Pagel of <br /> EHD 16-24 (2n"pg) 413/13 �'� IJ FOOD PROGRAM OR CONTINUATION <br />