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Q�aV•n.. SAN .IOAQUiN COUr <br /> y :< <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> 4clFdti�� Telephone:(209)468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: - �� p� ( Date: '/ y <br /> ddress: �� City: „ Zip Code: <br /> Owner/Operator: cl Telephone: <br /> Program Element: ProgramRecord: Inspection Type: t rA <br /> B180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> sZ 0 <br /> alo <br /> (4d 44 <br /> /iu•c a c <br /> r 'i0lh- <br /> n <br /> /h Mme. <br /> A- 7r4kbig JK� <br /> © k A &0A ` <br /> Item/Location Temperature Item Location Temperature <br /> '0644L 0 <br /> Cdz <br /> Lo <br /> _Foo_d Safety Certification Facility Hot Water Temperature Warewashing _J'F <br /> Name: and Sink: ZV <F hlorine: ppm eat:Exp.Date: arewashing Sink. of uat.Amm.: ppm ther: <br /> Received By/Title: I , <br /> EH Specialist: Phone: r �9133 <br /> ime in: Time Out: () _ m @r VV Page of <br /> EeD 1624 (2b Pp) 4IN13 �J FOOD PROGRAM 018 CONTINUATION <br />