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SAN JOAQUIN COUNIP, <br /> .COG <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.slgov.org/ehd <br /> �1FORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: OLbgn Z2 e4 m i 5 h6t v-e d Date: .� <br /> Address: r ei� 1 City: n Zip Code: 1-7-03Owner/Operator: Y Y� T �l /U Telephone: <br /> /_ <br /> Program Element: 3 3 Program Record/: Q� a G Fj Inspection Type: / O U77L <br /> " rt�. <br /> S6180 Posted _Yes ❑ No Permit Posted Yes No c, 3 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> / L <br /> .1 c( h a u I u451S orne Q <br /> A O n L, aLm <br /> -K -ftp 4�651w,e_ r <br /> G �fKK 3 /l <br /> Item/Location Temperature Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: Chlorine: pp Heat: <br /> �•, cLtG rb / fid �F l m °F <br /> Exp.Date: arewashing Sink: of Ouat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: ^, V o Phone: <br /> Time in: I C Time Out: Page, of <br /> EHD 16-24 (200 pg) 1/18/12 FOOD PROGRAM OIR CONTINUATION <br />