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SAN JOAQUIN COUP <br /> �-� ENVIRONMENTAL HEALTH DEPARTMENT <br /> N: X <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> �!F°R <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: < f\ �. �M # A __ "V Date: <br /> Address: t . � U r City: �. zpc -t-� Zip Code: /y �Z 1 <br /> Owner/Operator: rQm I L (� Telephone: `994-- /_(aZ <br /> Program Element: Program Record: —1 12-1 Inspection Type: <br /> B180 Posted ❑ es ❑ Permit Posted es ❑I 1 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS` <br /> S Uro 111 C _ jh du 5 <br /> MeMWS G^�'f" hr✓ cJt1 S�4C- MCA i t o Q <br /> F fiv t s tom\� 201 <br /> tem/Location Temperature Item/Location Temperature <br /> Facility Hot Water Temperature '" Warewashing <br /> _� <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of uat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: /;. ,_2 <br /> Time in: G�1; t Time Out: �j TJ 4 4 J Page I of <br /> EHD 16-24 (2ntl pg) 4131113 1� FOOD PROGRAM OIR CONTINUATION <br />