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oP° '"• SAN JOAQUIN COUP_ <br /> a. ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> 4t/Faa4;4 Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of.Facility: pQ Th 10 A"717 7 Date: <br /> ddress: Vh *Af* City: Zip Code: <br /> wner/Operator: a. .,( -!/(l _ � Telephone:10 <br /> Program Element: A903 Program Record: --7 l C U Inspection y e: V <br /> 8180 Posted ❑Yes ❑ Remiit Posted ❑Yes ❑I Re-Inspection on or tter. ' <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> �✓V <br /> C 1 Cctix adoe 96w-1v <br /> ItemlLocation-. Temperature ' Item l Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: and Sink: FChlorine: ppm Heat: •F <br /> xp.Date: arewashing Sink: eF uat Amm.: ppm ther: eF <br /> Received By/Title)Y N <br /> /` G p <br /> H Specialist: Phone: -— <br /> Time in: / I Time out: J Page of <br /> EHD 152E (2"Pg) Q113 FOOD PROGRAM OR CONTINUATION <br />