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SAN JOAQUIN COU I <br /> Z� ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ = 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sl4ov.orQ/ehd <br /> <<Fosea <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: --) __I _ I <br /> Address: cS`, -2- \ City: Zip Code: cl S <br /> Owner/Operator: Telephone: <br /> JJ <br /> Program Element: ib -1 Program Record: `� 13 Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> \�. -�U � _ I� \m.���c�� �'r ' J� ver-►-� - �, <br /> - <br /> _� '-k <br /> 2 <br /> C Z <br /> br — <br /> �oM� ti <br /> S`� 2 Mme.,;✓�,r <br /> v <br /> Cy— PQ\J�CKQ <br /> 01 <br /> n <br /> t <br /> ------------ <br /> Item/Location Temperature ' Item!Location 7 Temperature <br /> i <br /> Food Safety Certification Facility Hot Water Temperature { Warewashing <br /> Name: 1Hand Sink: of Chlorine: ppm IHeat: F <br /> Exp.Date: Warewashing Sink: -F Quat.Amm.: ppm (Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: "-A <br /> Time in: 5 Time Out: Pagel of <br /> END 16-24 (2n1 pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />