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SAN JOAQUIN COU= <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • ., ;� i eiephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.slaov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ; Date: <br /> Address: Q City: Zip Code: z a <br /> Owner/Operator: Telephone: <br /> Program Element: Pro7am Recor • w2t <br /> O ,►� Inspection Type: t�F <br /> '7 ' <br /> �S9180 Posted Yes o Permit Posted es No Re-Inspection on or After: 1 rt 5_-,9 <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> au S on q <br /> w \ 11 <br /> C + 1 r <br /> f 1 <br /> AA <br /> - X vll' <br /> 1 <br /> VIV- <br /> ^ 1 0 <br /> <JX rQ _ ,'lf1 �;6144'+o"r— 12�&r 14_0 1--_ <br /> 42 ' � P <br /> r <br /> e <br /> Item/Location ' FTemperature Item/Location i'Temperature <br /> I <br /> Food Safety Certification Facility Hot Water Temperature�� -'y--�1(Varewashing v <br /> 1"- .....__ <br /> Name: �i ` ;� ������� Hand Sink: —� `F Chlorine. ppm Heat: F <br /> c� - <br /> Exp. Date: Warewashing Si k: �? F IlQuat. Amm.: ppm Other: of <br /> Received By/Title: CA <br /> y <br /> EH Specialist: Phone: <br /> Time in: Time Out: Page of <br /> • L.J <br /> EHD 16-24 (2^^pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br /> �'iGlc✓p;�Go-n! <br />