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,oPa .�aG SAN JOAQUIN COUN <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> cq.. -.��P Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> R <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Ae., Date: <br /> Address: q LJ O aC�i G v City: s Zip Code: <br /> Owner/Operator: ��,t Telephone: 6 0Y O� <br /> Program Element: 3 6AProgram Record: A 0 5'2 / _ < �6 Inspection TypeAnd / <br /> SB180 Posted YQYes No Perm itosted Y <br /> Pes No QP c/P Re-Inspection on or After: <br /> a <br /> OBSERVATIONS AND CORRECTIVE ACTIONS KOM <br /> s <br /> 6-06-d CeY W a4-YI-/-- u OQ C73 urrt 71V S <br /> UV1,a �rz <br /> Item/Location Temperature Item/Location Temperature Item/Location Temperature <br /> M 11L r 37F <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Han ink: of Chlorine: ppm Heat: of <br /> T00,,Y7 3 <br /> Exp.Date: Warewashing Sink: of Quat t�°„„pm 11 <br /> Other: 'F <br /> Received By/Title: — J�� <br /> EH Specialist: V''vl Phone: g53 `72/2 <br /> Time in: Time Out: Page of Z <br /> EHD 16-24 (2^d pg) 4/9/12 FOOD PROGRAM OIR CONTINUATION <br />