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I <br /> ot�ul"' c SAN JOAQUIN COUNTY <br /> Z-+ ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ - 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sogov.org/ehd <br /> �IFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Ic - / -/Z <br /> Address: u 5 h r City: /'Lt Zip Code: <br /> Owner/Operator: c\ t C ,t Telephone: k,3 <br /> Program Element: Program Record: �0 L'� X315 Inspection Type: 0d1Jc1 I 4: <br /> SB180 Posted - Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> ode,4 1Jr� ' C r iJ 61,Ti"_'"� liJ <br /> C I k o/1 I I?'1 rYlCf 1110 <br /> - <br /> rr'iclncr an � o�;L+ /ler- <br /> J <br /> C rr� n hrc � -' � a <br /> Odle ' c, It/ r 1r !'1G- /7 o I >' ?'� 1 C I' <br /> Item/Location Temperature Item/Location Temperature Item 1 Location Temperature <br /> Food Safety.Certification Facility Hot water Temperature Warewashing <br /> Name: > Hand Sink: of Chionne: ppm Heat. F <br /> Exp.Date:,' „ arewashing Sink: 'F Quat.Amm.: ppm Other: `F <br /> Received <br /> EH Specia' Phone: <br /> Time in: L\ Time Out: Y Page of <br /> i <br /> EHD 16.24 (2m pg) 1112109 FOOD PROGRAM OIR CONTINUATION <br />