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1 <br /> 0t*4u'" Q SAN JOAQUIN COUNTY <br /> :Z ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> • �q •. ;a• Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sogov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: w , — _/j Date: Z 7'A <br /> Address: / City. Zip Code: , <br /> Owner/Operator: 7 Telephone: 7� <br /> Program Element: Program Record: oV3Inspection Type: 0 <br /> K8-0posted Yes No Permit Posted Yes , No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> K &014' -` <br /> (7)'zVW ✓t (C Ern< 1 <br /> 1 al/41 Gtr l K 1 i ,k <br /> r Jr -ti <br /> ' Aecn/Locatiop Temperature Item/Location T.empwature <br /> Food Safety Certification Fac-lity Not Water Temperature — Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> SINN on - <br /> Exp.Date: 61z i <br /> ZG,• arewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: J <br /> EH Specialist: Phone: <br /> Time in: Time Out: o Page Lof <br /> EHD 16-23 (2"d pg) 07129109 if FOOD PROGRAM OIR CONTINUATION <br />