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°"'" SAN JOAQUIN COUNTY <br /> �o 'c�G <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.slgov.org/ehd <br /> �IFOFttl <br /> FOOD PROGRAM OFFICIAL. INSPECTION REPORT 1 1 - <br /> Name of Facility: Date: <br /> Address: \ City: Zip Code: 9 S <br /> Owner/Operator: C _Cr�� Telephone: <br /> Program Element: \--7\_2 Program Record: f�b 1 Inspection Type: Ric, <br /> V 1 <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 2k ACI&2_11 <br /> Item/Location Temperature Item/Location. Temperature <br /> 1 -" <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: ; of Chlorine: ppm Heat: of <br /> Exp. Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By I Title: 5 ` Cw <br /> EH Specialist Phone: ^�2 <br /> Time in: kq y-1-- 2_ ',S4 Time Out: ,�'. J0 Page of <br /> EHD 16-24 (21"pg) 4/3113 �J FOOD PROGRAM OIR CONTINUATION <br /> bo•t C\ <br /> C- 0\r t e <br />