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SAN JOAQUIN COUP_ <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.s'gov.org/ehd <br />clkC"a` <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />Ij <br />Date: <br />,(,I <br />ddress: <br />v beet- <br />I <br />' r1` <br />to <br />City: �(Q_V_j Zip Code: <br />G) <br />Owner/Operator. <br />uQ!l <br />Telephone: 201 32 <br />-392 <br />- IK <br />`�_I <br />Program Element: <br />Program Record: <br />Inspection Type: <br />8180 Posted <br />0 Yes 0 Rermit Posted D Yes 01 <br />Re -Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />Y <br />iS vgnq <br />cA <br />non- pa*mjt4erj <br />vehiae. <br />1w <br />to i f v <br />i c,Le <br />Item/Location <br />Temperature <br />Item / Location <br />Temperature <br />Food Safety Certification <br />Facility Hot Water Temperature Warewashing <br />Name: <br />Hand Sink: <br />'F hlorine: ppm Heat: <br />"F <br />Exp. Date: <br />Warewashing Sink: <br />"F uat. Amm.: ppm ther: <br />"F <br />Received By / Title: • <br />i <br />H Specialist:RW <br />19 Z�Phone: <br />fig�J <br />Time in: II :(50 <br />Time Out: '�, <br />Page <br />of <br />EHD 16-24 (2' pg) 46113 FOOD PROGRAM OR CONTINUATION <br />