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SAN JOAQUIN COUt
<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: Dckv. , Tc.bot.. 4, cmcp‘.5 t cvk Date: Wg7/6
<br />Address: lic-16b 14 City: s\ir..,"ovk Zip Code: c-45 7 05—
<br />Owner/Operator:
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<br />Telephone:
<br />Program Element: Program Record: Motio•A ),461.- Inspection Type: , Od 1
<br />SB180 Posted 9 No Permit Posted Vs No Re-Inspection on or After:
<br />OBSERVATIONS AND CORRECTIVE ACTIONS
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<br />Ithm/Location Temperature Item / Location Temperature
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<br />Food Safety Certification Facility Hot Water Temperature Warewashing
<br />Name:
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<br />Hand Sink: .F Chlorine: 10 0 Heat: PPm °F
<br />Exp. Date: Nrcaxit.....
<br />Warewashing Sink: . Quat. Amm.: PPm Other: °F
<br />Received By / Title:
<br />EH Specialist:
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<br />Phone:
<br />ime in: A.. . .visiz Time Out: c\ Time "r" ot An. Page of
<br />EHD 16-24 (29g) 4/3/13
<br /> FOOD PROGRAM OIR CONTINUATION
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