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P <br /> SAN JOAQUIN COUNT Y <br /> 2� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.s*gov.org/ehd <br /> L/FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: o, -4 Date: 7 <br /> Address: Au. City: — Zip Code: y S3 c V <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: � <br /> S131 80 Posted ❑Yes ❑ No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> P C e iA a h e t r cuv(,( YAS>f oci,41. <br /> C0r10C � <br /> 0 y l; � Sill n 1 A .0)\ G3n d s IA " <br /> �S f to o c 1,3. fc // A <br /> e rri. 1 a r, 1 ;✓ 4 .1edo s 1 ; f; e b , <br /> t'r rn q r �or PSS ti! h n el s� 2 <br /> 0� n P9 <br /> Item/Location Temperature Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hjqnd Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> ime in: G Time Out: F'l l9 Page of <br /> EHD 16-24 (2w pg) 1/18/12 FOOD PROGRAM OIR CONTINUATION <br />