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SAN JOAQUIN COLIN <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ = 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sagov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ' 7 v` Date: J <br /> Address: /- ) � {fie City: Zip Code: <br /> Owner/Operator: Telephone: _ A 3 <br /> Program Element: / Program Record: © - Inspection Type: n, 17 <br /> 13180 Posted (Y ❑Yes ❑ Rermit Posted ❑Yes ❑1 Re-Inspection on or After: <br /> IS <br /> i00 <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> . <br /> JP.c � rtie ��YVI-. <br /> w Z <br /> ✓t.� <br /> C� cu <br /> U CA wz(_wU vwt'tw vYvN <br /> C c�v►�e fJv r� qrlfak . D ✓1tiy <br /> VP n C4 <br /> VUVL?- k- -r I, w r Vie' <br /> W b „v> c •C f <br /> low r <br /> Item/Location Temperat re 1t �n 1 Location Temperature <br /> .W__-._ � � �• .. — _� _ _._.. __�... _. <br /> C(�iv�.�'� 1le,a c��--r-►-� n o(n 1 <br /> Food Safety Certification Facility Hot Water Temperature Warewashfn <br /> Name. Hand Sink: of Chlorine: ppm Heat: of <br /> Exp. Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: 42 F <br /> EH Specialist: Ir Phone: <br /> V 4 [ l <br /> Time in: ) ' Time Out: Pagel of <br /> EHD 16-24(21d pg) 413/13 V FOOD PROGRAM ORCONTINUATION <br />