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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />�P Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.s*gov.org/ehd <br />4<<FORN <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: o <br />yj <br />Date: •'+✓,t7� ?, - <br />Address: p®®, i� <br />Owner/Operator: _ <br />C�1r1 <br />�11 <br />SS ��� City: <br />r-C4 <br />` Zip Code: Ck ^Z� <br />Telephone• u, <br />'' <br />Program Element: cst <br />SB180 Posted Yes No <br />Program Record: <br />Permit Posted Yes No <br />Inspection Type: 5-4 <br />Re -Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />.int' <br />4C 44 <br />h'A LAA <br />•W1 <br />MilMS c,4,, <br />e <br />Za zo <br />Item/Location <br />Temperature <br />Item / Location <br />Temperature <br />Food Safety Certification- <br />Facility Hot Water Temperature <br />Warewashing <br />Name: <br />Exp. Date: <br />Hand Sink: ' <br />of <br />Chlorine: ppm <br />Ouat. Amm.: ppm <br />Heat: of <br />Other: of <br />Warewashing Sink: <br />of <br />Received By / Title: <br />EH Specialist: <br />Time in:Time <br />Phone: b <br />Out: 2. 30 to" Page' of <br />EHD 16-24 (2"d pg) 4/3/13 1 F FOOD PROGRAM OR CONTINUATION <br />