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SAN JOAQUIN COUNT <br /> 2� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> • ... _ :P Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sogov.org/ehd <br /> 4��FORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: / ZZG Date: <br /> Address: 3 P_/ 'G City: Zip Code: <br /> Owner/Operator: Qn ` Telephone: <br /> Program Element: 16,�i/ Progra ecord: P2 b JSI 5 3 / Inspection Type:ah� ' <br /> !!l <br /> SB180 Posted �qes ❑ No T Permit Posted Yes ❑ No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> t-h&..,l CA CP— w c f,c <br /> r G G/t o rr' f-I>— r tm r r e oe ct r-p— <br /> o -f 7' o-F 1 'q I za cr-k <br /> cLLt cJ w <br /> S -e_ r .2 <br /> +7 <br /> 0 5 o c� w.e <br /> c� r tea( ,' r S4o v--e- 0 ct T-S 'qLg <br /> v <br /> handle <br /> e a d 47' <br /> u <br /> r - <br /> 1 c-v r- GL <br /> U4 4a Ce <br /> 1 a y r <br /> o i rC4 2i'd <br /> 0 <br /> r <br /> - - I <br /> 'Ji <br /> em/Location Temperature Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warms�ngjSink: /a�L 'F Quat.Amm.: ppm Other: 'F <br /> Received By/Title: T <br /> EH Specialist: /_ _ Phone: <br /> Time in: / -, �1 w[�J Time Out: -/a , S Page of <br /> EHD 16-24 (2m pg) 11 2/09 FOOD PROGRAM OR CONTINUATI N <br />