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SAN JOAQUIN COU Y <br /> Z-� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> cq., NSP Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> LlPOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: U f -',..i fiC� <) r;-�U `� h Date: , S <br /> Address: a 4ce)) M���h -1; — City: Zip Code: qP— <br /> Owner/Operator: 16.m i 1 f�nl''Q` a Telephone:-�G' _4401_0[� <br /> 1 Program Element: i /„G e t� Program Record. Inspection Type: Cc�IVT7I`I 41"("'n <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> _ _ ObVe _—� _ cocr� aCS Sri <br /> .......... <br /> _ <br /> vock M GnCAW -h' c 4e n a <br /> n 1Q - ceAOS 1\ <br /> _.__._.._...___ Off- iv 1 SS� ca] � 'U O�- (SU G S <br /> I lcv2- <br /> Item/Location :.'Temperature Item J Location i Temperature <br /> --T— <br /> ------ <br /> 'h1 <br /> Food Safety Certification Facility Hat Water Temperature ". Warewashing <br /> Name: Hand Sink: .J C) `F Chlorine: ppm Heat: `F <br /> Exp.Date: a�rew�a{shin Sink: U of Ouat.Amm.: ppm iOther: of <br /> Received By/Title: <br /> EH Specialist: Phone: 1 o <br /> Time in: I v : Time Out: Io 0 Page of <br /> EHD 16.24 (2n1 pg) 4/3113 FOOD PROGRAM OIR CONTINUA ION <br />