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SAN JOAQUIN COUF <br /> N: X <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �4..-. Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.si ov.org/ehd <br /> ehd <br /> �1FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: fiG�> R G n Date: `/Z z/I - <br /> Address: �2 MCtjn �f- City: C1>tb t,. TM Zip Code: n1�2C <br /> Owner/Operator: �i m UnGl n D 1 w� Telephoner <br /> Program Element: Program Record: Inspection Type: v;Sr <br /> SBI80 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> -.........--- ---r— <br /> f faC01414 as �C* dlN u U�� 1 <br /> be Cyo�,W yr+�l Vel 4 i S VO-0 ----- -- -- <br /> ltenVLocation ) Temperature Item I Location Temperature <br /> . <br /> ---- _ ............_..----- —._.._...__ _........a — <br /> - - — - --- <br /> Food Safety Certification Facility Hot Water Temperature ( Warewashing <br /> Name: Hand Sink: ,.F Chlorine: PPM Heat: `F <br /> Exp.Date: Warewashing Sink: F Quat.Amm.: PPM Other: `F <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: Time Out: 10 <br /> V/-'0 Page I of <br /> EHD 16.24 (21d pg) 4/3113 FOOD PROGRAM OR CONTINUATION <br />