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SAN JOAOUIN COU. Y <br /> y� ENVIRONMENTAL HEALTH DEPARTMENT <br /> = 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT N/ ' (e_ <br /> Name of Facility: 'a 0 CC 5, ✓ l Date: 'y_3Ci _l/ <br /> Address: - 0/ r.e ` -Z)r, City: �I Zip Code: 9 5 <br /> Owner/Operator: i Telephone: <br /> Program Element: ) U Program Record: �Q 0 ���S Inspection Type: <br /> SB180 Posted XYes ❑ No Permit Posted -,.,Yes ❑No Re-Inspection on or After: I <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> -�DDc�( ��(P� R r� - - -�✓'.r —/�a.e.1C-a Gl-sof S r,car �•�'_s - <br /> d <br /> Item/Location Temperature Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: 'F Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: "F <br /> I- I <br /> Received By/Title: <br /> EH Specialist: K AUA msAvv Phone: <br /> Time in: 87/ 6 Time Out: PageLof <br /> EHD 16-24 (20°pg) 11/2/09 FOOD PROGRAM OIR CONTINUATION <br />