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oa41'"• SAN JOAQUIN COUN1 Y <br /> Z� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> . �.., ;o • Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> ��lFOR� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 77 G u e en 4 &raw 9r,5 ! Date: <br /> Address: City: r Zip Code: 953 �b <br /> U �en � h S1l• ra <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> SB180 Posted ❑Yes ❑ No Permit Posted n Yes L No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> l 5 ZOIC u IK <br /> YC le On C b 10 C 4 0 1 r1V r 3 : 4 h n <br /> qb I5 . Cc or re C adg <br /> 2AR VICA r l- 00, C1 bro JlP."L7 <br /> L . h 4 0 1/0 re ll ed /arc? <br /> ; n <br /> Item/Location Temperature Item/Location Temperature f Item I Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature, Warewashing <br /> Name: �' /C, Hand Sink: /6),9 f- of Chlorine: ppm Heat: OF <br /> Exp.Date: -/J <br /> arewashing Sink: / _ of Quat.Amm.: ppm Other: OF <br /> Received By/Title: <br /> EH Specialist: Phone: L .3/6 <br /> Time in: �S Time Out: /DO,.y Page of <br /> EHD 16-24 (2n°pg) 4/9/12 FOOD PROGRAM OIR CONTINUATION <br />