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SAN JOAQUIN COL 'Y <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468 3420 Fax: (209) 464-0138 Web: www.sigov.orq/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />A <br />Date: <br />Address: �,� r <br />�w �l. City: <br />� _ M t �n Zip Code: ci5�zC? <br />c t�--c� <br />Owner/Operator: 5 <br />Telephone: q -7-3--19/ I <br />Program Element: t l p�� <br />Program Record: (� �j2"]5'7 <br />` <br />Inspection Type: iou- fi fir <br />SB180 Postedes No <br />Permit Posted 7�_Yes No <br />Re -Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />-FoQ a <br />6 a C.2 n r Z5 6 Y, -e - p ea— c VA <br />r D -I- Y�2 ►� e YJ -- 1-: <br />40 <br />A m 6,,- <br />4y c..Gt <br />r rya <br />ItemJl ovation _I Temperature <br />Item J location <br />Temperature <br />Food Safety Certification <br />Facility Hot Water Temperature <br />Warewashing <br />Name: <br />Hand Sink: <br />of <br />Chlorine: ppm <br />Heat: 'F <br />Other: �F <br />Exp. Dat <br />Warewashing Sink: <br />of <br />Cluat. Amm.: ppm <br />Received By / Title: <br />I WIN <br />a nQJ <br />EH Specialist: <br />/_ L <br />T <br />Phone: <br />/ <br />Time in: • ! t <br />Time Out: Paggof <br />EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />