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SAN JOAQUIN CiOLIN <br /> � ENVIRONMENTAL HEALTH DEPARTMENT <br /> a: •ya <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> �fFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ()q '-,. Cj' 4A 4 M 214_ Date: I3 <br /> Address: wkr�&+aty. (;4D1* � Zip Code: <br /> Owner/Operator: 1 v Telephone: <br /> Program Element: Program Record: J� Inspection Type: (G1`1 10rni- <br /> SB180 Posted ❑Yes ❑ Rermit Posted ❑Yes ❑I Re-Inspection on or After: �— <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> n G I C wt <br /> c�cl I s us m un ,e m� �e�1 � aco c. II <br /> C CMu c t-i w Ith Th-e -Tv-a i LaT . <br /> - pisc��11-inu-P v�SinG TUC-0 Cck� t +OdcN <br /> Item/Location Temperature Item/Location' Temperature <br /> Food Safety Certification Facility Hat Water Temperature Warewashing <br /> __....._ <br /> Name: Hand Sink: of �Chlorine: ppm Heat: F <br /> Exp.Date: arewashing Sink: of at.Amm.: I ppmOther: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: ,I 2 <br /> k j I Time Out: `1 l�D Page of <br /> EHD 16-24 (2ntl pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />