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°"!" SAN JOAQUIN COUN <br /> za ENVIRONMENTAL HEALTH DEPARTMENT <br /> N: •< X <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> ��FpR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: �� - �� ( � Date: <br /> Address: City: Zip Code: <br /> Owner/Operator: Telephone: ec�( <br /> Program Element: Program Record: Inspection Type: I J }o <br /> SB180 Posted F Yes Rermit Posted E Yes ❑ 1 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> f�U Yv0( q fi 0 n CCo I-, 'FCkCA 1 1 \v ' 11 C 1 <br /> W 4op- S G <br /> NoT - Ur hc,4 rd W � an - - <br /> S 0 <br /> r-O CI I I-M 1 S C crv-n (Ar\G i ncAj <br /> kA W 0 F4A G 0q 2j �TAce tD <br /> �tz�v 1 s ccmfi n u.(_2 -Dd u Can G On k . . PJI1 w h C) Ue- <br /> i S Gtr) av�e_ hoO - s <br /> Item/Location I Temperature ! Item!Location Temperature <br /> ysM� Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: aF <br /> - _ pp - -- <br /> Exp.Date: arewashing Sink: of Quat Amm.: m Other: of <br /> Received By/Title: <br /> vI <br /> EH Specialist: Phone: <br /> Time in: UIj Time Out: : +c Page I of <br /> EHD 16-24 (2"d pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />