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4"!" SAN JOAQUIN COU f <br />11 -c�G <br />X ENVIRONMENTAL HEALTH DEPARTMENT <br />_ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.s4gov.org/ehd <br />�iFORa <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />r `_G __ 1 <br />+"�T <br />Date: <br />—2 , -1 <br />Address: i i c <br />City: <br />� <br />L1_0 <br />Zip Code: <br />Owner/Operator: <br />in <br />Telephone: <br />Program Element: Z <br />Program Record: ��' <br />Inspection Type: _ <br />t <br />8180 Posted <br />Yes F Permit Posted Yes ❑ I <br />Re -Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />YYiO <br />-hon w ' <br />co r&_ <br />" <br />r lel <br />w' <br />o <br />t Jnr So <br />rn- dz <br />!:ai c) <br />a c -f CA, <br />Te <br />0 ,r <br />O -1c <br />r CD <br />s Lt <br />L"n <br />Y -e- <br />c Y- <br />rtim- ' -pi-,ocd <br />6ue-0 r i VI 8A, n Y\_k <br />a wo <br />c)l-i C.n it L <br />U c..i-n_2 4� <br />4-a_144 yuo, <br />Item/Location , Temperature <br />Food Safety Certification Fa ;;, <br />Name: Hand Sink: <br />Item J Locatio `' <br />Warewashing <br />of hlorine: Heat: <br />Temperature <br />°F <br />Exp. Date: <br />arewashing Sink: <br />ofQuat. Amm.: <br />LPPMM <br />Other: <br />of <br />Received By / Title: <br />EH Specialist: <br />Time in:` c>� <br />Phone: <br />Time Out: <br />Page of <br />EHD 16-24 (2na pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />