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SAN JOAQUIN COUNTY <br /> Z� 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 /> �/FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: r /A1Date: S <br /> Address: 32oc:s N A City: Zip Code:9 5 3 <br /> Owner/Operator: lyk C! fi3 �a�Fr�r.R,�/v J Telephone:? <br /> Program Element: l 4 r 5— Program Record: Rej 5—�s�y� Inspection Type: <br /> SB180 Posted XYes No Permit Posted Ves No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Run/Location Temperature Item/Location Temperature Item/Location Temperature <br /> I <br /> I <br /> Food Safety Certification FaciUty Hot Water Temperature Warewashing <br /> Name: Hand Sink: f� ofChlorine: ppm Heat: of <br /> Exp.Date: 8-21 I3 0' g Sink: (o 'F Quat.Amm.: ppm Other: o f <br /> Received By/Title: <br /> EH Specialist: Phone: /�/ <br /> -f rq7 <br /> Time in: /f e-vi Time Out: ;2 Page 2f <br /> EHD 16-23 (2ntl pg) 11/06/0 FOOD OR CONTINUATION <br />