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SAN JOAQUIN CA& <br /> a ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • c4..,.,c.a;P'• Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sogov.org/ehd <br /> ��FOR <br /> -k rr" <br /> 1A I FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: I U Date: I v/"7- V l } <br /> Address: 2I C-V � > I City: Clfi(jC� Zip Code: i�j,-_-,261":- <br /> Owner/Operator: M eA' bel "-1a Telephone: <br /> Program Element: ;(a-A� Program Record: F V_V%3���sG, Inspection Type: G <br /> SB180 Posted Yes No Permit Posted YesNo ✓�' Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> M n me - <br /> �-I-PX eS (.e ) - <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: 'F Chlorine: ppm Heat: °F <br /> Exp.Date: Warewashing Sink: 'F Ouat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> ime in: Time Out: ,: JU `CJ Page (of <br /> EHD 16-24 (2^'pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />