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,gP4 .coa SAN ..JOAQUIN COU,, <br /> W :< ENVIRONMENTAL HEALTH DEPARTMENT Top <br /> X <br /> J. <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • cq.. a`PTelephone: (209)468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd Coo+ <br /> LlFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT 2Z_ <br /> Name of Facility: k-'\k Date: / <br /> Address: n -� h City: S Zip Code: <br /> Owner/Operator: Uw 1 1 CA Telephoner <br /> Program Element: � Program Record: Inspection Type: <br /> SB180 Posted Yes ❑ Rermit Posted ❑Yes /I Re-Inspection on or After: ' NuJ <br /> OBSERVATIONS AND CORRECTIVE ACTIONS __ <br /> YO of s - ��?-wide <br /> cro COO w <br /> u9n a - 1 <br /> Cu a► kt and -cam VRAAWS r -V r0+ <br /> c� <br /> S'W ' KWItab 01 C alt ` v S <br /> ItemlLocation Temperature fl Item/Location emperature <br /> T >1"hC1L2S <br /> Food Safety_Certification Facility Hot Water Temperature Warewashing <br /> Name: \A/q �� Hand Sink: of 'Chlorine: ppm ,Heat F <br /> Exp.Date: .?J ' YJ� �Warewashing Sink: of Quat. Amm.: ppm 'Other: F <br /> Received By/Title: 1�— <br /> EH Specialist: Phone: <br /> — - <br /> ime in: , <br /> UTime Out: `2 Page lof <br /> WY <br /> EHD 16-24 (21 pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />