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SAN JOAQUIN CO.- TY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> - = 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> gc,FORa <br /> :P Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: —� 9 a ! ! Date: �a <br /> Address: �a r yu a 7 City.? C.� JL Zip Code: <br /> Owner/Operator: i' an7 J Z �7 Telephone: LtDI — _73 <br /> 3 <br /> Program Element: J Program Record: c,D/(a323 G Inspection Type: 'l <br /> SB180 Posted (Yes No Permit Posted es No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS , <br /> f Sc� Gcvd Si Wr <br /> o _-ro,—.,S prov4jj <br /> Y Or Ud <br /> 5' L'a 6 d)c ' w+ Uj 0r ✓t <br /> 1'L )r-1 V-e-r A"CL <br /> J'l Y-,) -e-+ la c3 <br /> L Co r <br /> Q_. Yc <br /> Item/Location Temperature I� Item/Location Temperature <br /> ev hox - - <br /> 7 7— <br /> y5�am <br /> etCettrfic #lbn Facility Hat Water Temperature I — warewashing <br /> Name: Hand Sink: 11 F Chlorine ppm Heat: of <br /> Exp.Date: iWarewashing Sink: `F IQuat. Amm.: m Other: <br /> l F <br /> ISS PP <br /> Received By/Title: <br /> EH Specialist: G{/LA /_ _ _G Phone: q 13 <br /> 9 1 <br /> Time in: 00 Time Out: � Page.. <br /> EHD 16.24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />