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SAN JOAQUIN COUN' <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> . �4.,. ,.�;;P• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.orq/ehd <br /> L/FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: �f-eC4 4A Date: <br /> Address: F— CQf 1 n I City: Zip Code: Z � <br /> i1."T� l�d- <br /> Owner/Operator: -j—Ci z"(D 12 kc;,-L4-r. Telephone: ss_ <br /> Program Element- 16 3 Program Record: o5.38 75'-2— Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: h T <br /> QBSERVA IONS AND CQRRECTIVE AC37C7NS '$ <br /> i �� cew *s< rs <br /> _�. _...._...................................... ---._- -...- - -------......................................._..... <br /> .____._._ <br /> .............. <br /> Item/Location Temperature Item J Location Temperature <br /> Food Safety Certification F Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: °F Chlorine: ppm Heat: `F <br /> Exp.Date: arewashing Sink: -F Ouat.Amm.: ppm Other: -F <br /> Received By/Title: <br /> EH Specialist: /V `9c� Phone: e—l( — 3 Y y <br /> ime in: -310 Time Out: g • y5— Page/of <br /> EHD 1&24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />