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PQ"I" SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> • �4... �;;P• Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sj4ov.org/ehd <br /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: J /2. Date: /0- / 2 -/(_) <br /> Address: a _� City: Zip Code: <br /> q 5.:2d <br /> Owner/Operato . 9 ' Telephone: Y 7�4-/0,;L-7 <br /> Program Element: /012— Program Record: PA01&063 Z <br /> Inspection Type: P 6-14 4? L , <br /> SB180 Posted Yes ❑ No Permit Posted, '.Yes 0 No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS- <br /> r U <br /> 1 i7 <br /> 00 <br /> r <br /> LSD vt/2 r <br /> k <br /> r r r n <br /> Item/Location Temperature tem/Location Temperature } Temperature <br /> U - _ <br /> y3 <br /> Food Safety Certification FacilityHot Water Tempe[ature Warewashing <br /> ---- <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: arewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: / L Phone: s _-72 l? <br /> Time in: /(- Time Out:�p �r d Page hof <br /> EHD 16-24(2nd pg) 1112/09 FOOD PROGRAM OR CONTINUATION <br />