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wry. c SAN JOAQUIN COUNTY <br /> ?� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> c... ;P• Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> '0�;F�•R�.i <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: r \ E Date: <br /> Address: ,tb U r \_ 0 , City:�— � zip Code: S <br /> Owner/OperaS <br /> Owner/Operator: `� `J Telephone: <br /> kble ��rnc <br /> Program Element:tb2 Program Record 52 b Inspection Type: ,_k_kr�L <br /> Fffo <br /> Posted ❑Yes ❑ Rermit Posted ❑Yes ❑I Re-Inspection on or After: l��V <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 5 S <br /> e CA <br /> A <br /> ^(r <br /> /�^ r <br /> ..� - .,; 2 <br /> G c ' <br /> Item/Location " Temperature 1� Item I Location <br /> r <br /> nor- <br /> Food Safety <br /> ?oFoodSafety Ce ification Facility Hot Water Temperature � Warewashing <br /> Name: ` - Hand Sink: ` ofChlorine: ppm Heat: F <br /> Exp.Da arewashing Sink: of uat.Amm.: ppm Other: �F <br /> - i-1 - 20Z <br /> Received By/Title: <br /> EH Specialist: \_ Phone: <br /> Time in: C" fY-N Y\ Time Out: ' . Page ,of <br /> c� <br /> EHD 16-24 (2'l pg) 413/13 1 FOOD PROGRAM OIR CONTINUATION <br />