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SAN JOAQUIN COWS
<br />ENVIRONMENTAL HEALTH DEPARTMENT
<br />1868 East HazeIton Avenue, Stockton, CA 95205-6232
<br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjqov.orq/ehd
<br />FOOD PROGRAM OFFICIAL INSPECTION REPORT
<br />Name of Facility: .,k N\ ...-,,_ ..5ro Cy" S2) -(2-,4e), *S-e3 Date: 9 _ k of- k cir
<br />Address: ‘Seic---) le..\ (v-\,__<.. pw ___0(.,„\ .A.../. City: k Zip Code:
<br />Owner/Operator: Telephone:
<br />Program Element: Program Record: Inspection Type:
<br />SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: c-2.4.2
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<br />, OBSERVATIONS AND CORRECTIVE ACTIONS
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<br />Item/Location Temperature Item! Location Temperature
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<br />Food Safetytertification Facility Hot Water Temperature Warewashing
<br />Name: v.,030,./2 _ Hand Sink: \ 2_ci .F Chlorine: ppm Heat: °F
<br />Exp. Date: et')1q/e/L P701( Warewashing Sink: ‘ 2. . q . F Quat. Amm.: ppm Other: °F
<br />Received By / Title:
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<br />Phone:
<br />Time Out: 2 .. , ,--, Page kof Time in: k ...,,,.,...„, l•--)p--(YA
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<br />EHD 16-24 (2nd ) 4/3/13 A tc., FOOD PROGRAM OR CONTINUATION
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