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�qt'A INV <br /> ..coG SAN JOAQUIN COU <br /> ` ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 a" " <br /> . •.. ;P.. Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.si4ov.orq/ehd (� <br /> 4t%Fo'Ri+ _u <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT 5 - <br /> Name of Facility: C-,& i 2 ~r, (�, Date: <br /> Address: ^7 City: Zip Code: <br /> 2 <br /> Owner/Operator: Telephone: <br /> Program Element: 1 r -_ Program Record: c 1 Inspection Type: <br /> B180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: f �^ <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> IF <br /> - ( ` ( �/ n �A e eh <br /> Off- -fir ZOI <br /> Item/Location Temperature Item 1 Location Temperature <br /> 2- <br /> Food Safety Certifications Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm �ea : of <br /> Exp.Date: arewashing Sink: \ 1 of Ouat. Amm.: ppm r: of <br /> Received By/Title: / �Cj C e'er L-i VL IT I rl <br /> EH Specialist: ly \ Phone: ^�3 <br /> Time in: o Time Out: (^ I c Page 1of <br /> { <br /> 0 > V J <br /> EHD 16-24 (20°pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />