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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> L�FOR� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 0694/04)s Coat"45 Date: .lE� <br /> Address: "1ST E 0" ST City: Zip Code: <br /> Owner/Operator: (5cow(F .'r42&_) Telephone: 9 2_30 7(( <br /> Program Element: 16W Program Record: Rb ? Inspection Type: <br /> VB180 Posted Yes No Permit Posted Yes No !! Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> kern/Location Temperature C Item/Location Temperature Item/Location Temperature <br /> li <br /> — <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: LI441 T— Hand Sink: of Chlorine: ppm Heat: of <br /> Exp. Date: 0 —1< ^/o arewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: r <br /> Time in: D�v Time Out: �Gz Page) o f <br /> EHD 16-23 (2^d pg) 07/29/09 FOOD PROGRAM OIR CONTINUATION <br />