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SAN JOAQUIN COL .'Y <br /> _ ENVIRONMENTAL HEALTH DEPARTMENT <br /> N: :t <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.s'gov.org/ehd <br /> tit:oRe� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 41 1 Date: (; I <br /> Address: +U 4-0 �e 11-VwO n City: Zip Code: <br /> Owner/Operator: 1 Y f p C� (2 j Telephone: U <br /> Program Element: 4 ClPfrogram Record: f� �C 2 P�� �� Inspection Type: _h cJ <br /> SB180 Posted ❑Yes ❑ Rermit Posted ❑Yes ❑1 Re-Inspection on or After: <br /> , OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 1 �1r i v i <br /> wa S v_e_ fi 1111 Y -�i GbZ Ulf &-14C <br /> iSSu� m + ufi TF-S rn� <br /> Item/Location Temperature Item/Location Temperature <br /> ------------------ <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> ., .._ <br /> Name: Hand Sink: of Chlorine. ppm Heat: °F <br /> Exp.Date: 11W <br /> arewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> -4Gt <br /> ime in: I U Time Out: Page of <br /> EHD 16-24 (2n'pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />