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oPQ"'" SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> C`gC/FORa�P• Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.s'gov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: r e f } S kL1 Date: l U. a <br /> Address: —(`'C nn I City: r Zip Code: 9 s3 -7 6 <br /> IJ v� r�C <br /> Owner/Operator: Telephone: ?'.13- 79 3 y <br /> Program Element: Program Record: Inspection Type: <br /> U U ti A Q <br /> SBI 80 Posted --Yes No Permit Posted ❑Yes E No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS { `a+ W <br /> jo <br /> Or J be I&w t r 40 d <br /> i der re CI- W., <br /> 3 ov: de C ✓er� G r a I S S'er e <br /> }e cl, <br /> Food scl fo ly cer Cie, le. le. f u <br /> - rrnc,; Wee <br /> N'd fe M012 S ; n G Kj c C K <br /> S �1►'�i �� ZPr• .SOC) -Y c !. <br /> Item/Location et, Temperature Item/Location Temperature Item!LocationTemperature <br /> �Mcn I Y _v r (16 f 6_01M".; _ <br /> a Food SafetyCertification Facility Hot Water Temperature' Warewashing <br /> Name: Hand Sink: O of Chlorine: ppm Heat: of <br /> Exp.Date: arewashing Sink: / of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: - Phone: <br /> Time in: j Time Out: C, Page of <br /> EHD 16-24(2nd pg) 1112109 FOOD PROGRAM OIR CONTINUATION <br />