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4"'" SAN JOAQUIN CO- .TY <br /> y� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �q. �;P• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.siQov.orp/ehd <br /> L/FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ��(J ��`� � � Date: C2_ <br /> ( . <br /> Address: lU ' ,i U City: S � Zip Code: G %7 <br /> Owner/Operator: \,Ad 10 v ,aT1 C Telephone: <br /> Program Element: Program Record: r5 4 <br /> Inspection Type: � ( <br /> SB180 Posted Yes No Permit Posted Ye No Re-Inspection on or After: _1�1 <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> glsk� PAEX h i fzx- U Ib <br /> �S v e' ex_'n PoCA , <br /> P f3od tODC"L94 (OfLS <br /> Item/Location Temperature Item t Location Temperature <br /> LS <br /> l -- - - <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> _ – ,—--- — .. — -- - _.. — <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: ,/2� Z arewashing Sink: of Quat.Amm.: ppm Other: 'F <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: <br /> ? ( U; rr Time Out: 'G -.S� Page of <br /> y`� <br /> EHD 16-24 (21'pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />