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SAN JOAQUIN COUNT' <br /> Q` ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> c... �p• Telephone: (209) 468-3420 Fax:(209)464-0138 Web:www.sogov.org/ehd <br /> 4 Cj F i).Ra <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Nom. �� yh \ - <br /> Address: <br /> - ( C Date: <br /> Address: c!7rt _t 1 �O� G St City: �-1 Zip Code: �7 G <br /> Owner/Operator: `C 1M UCS -VAC/,(es Telephone:� _r5 _Ct-A-(5 <br /> Program Element: Program Record: � q Inspection Type: . <br /> SB180 Posted es No Permit Posted Yes No 1 1� Re-Inspection on or After: �C S <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> u <br /> Ccanr�i— tSS� �P.t 1� 2 Olct unci <br /> Item/Location Temperature Item 1 Location Temperature <br /> _.. -........... <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Ouat.Amm.: ppm Other: -F <br /> Received By/Title: <br /> EH Specialist: ! Phone:7(�G , c�_?� �'j <br /> Time Out:Time in: <br /> Page I of <br /> EHD 16-24 (2^d pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />