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oP4uIM a SAN JOAQUIN COUNI� <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> • q.. ;P Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sugov.org/ehd <br /> �;FORS I g g E " AU-P2. RSZoS <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 5 C� Date: DS —/7— <br /> Address: <br /> Address: a K -q_���. /`�`City: n �l ak 1_Y�C Zip Code: 3-3Owner/Operator: �l-ff a f� Telephone: <br /> Program Element: ( Z Program Record: O /6 / D Inspection Type: 5 e / <br /> SB180 Posted Yes it Posted)QYe <br /> No Perms ❑ No ! Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 01,2 atY <br /> COr d c. Fcu- lo,Wc���� wJ` cis s <br /> o�orr��S <br /> t� Octp f x12 <br /> Item/Location Temperature Item/Location Temperature Item/Location Temperature <br /> Food Safety Certificoela ility Hot Water Temperature Warewashing <br /> Name: A Han in �S_ of Chlorine: ppm Heat: of <br /> Exp.Date: ewas i D f of Ouat.Amm.: UO ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in:1,R • Time Out: Page of <br /> EHD 16-24 (2""pg) 1/18/12 FOOD PROGRAM OR CONTINUATION <br />