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SAN JOAQUIN CAW <br /> �o. .CGG <br /> a` a ENVIRONMENTAL HEALTH DEPARTMENT <br /> N: X <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • c..• - �p• Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.slaov.orq/ehd <br /> 4GjFo'�iN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 6/h1 f' Fvoc # � Date: <br /> Address: 2 ; 7(< o City: �}r,� ,j ..�,� Zip Code: lam) <br /> Owner/Operator: m (•(�- Telephone: <br /> Program Element: Z Progr m Record: (_ - Inspection Type: { r? ( <br /> SB180 Posted Yes No Permit Posted Yes No r� Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> v AOl O-hvNS �vrrec ed �xc�(7fi= - <br /> Ly�tp �rrr� cc <br /> �CG�1n 71?-,on"e c� <br /> of -rhe (AN chyc4e i'uI <br /> Item/Location Temperature item/Location Temperature <br /> ---- -- -- --... <br /> ..... <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: OF Chlorine: ppm Heat: �F <br /> Exp.Date: Warewashing Sink: of Ouat.Amm.: ppm Other: 'F <br /> Received By/Title: G'cJ <br /> —� �_ <br /> EH Specialist Phone: lV 1� <br /> Time in: �U Time Out: ( -vz� Page l of <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />