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SAN JOAQUIN COUP { �, <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> a*c/Asa�� Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT 1� <br /> Name of Facility: 5 5 TL —1 \ 'L Date: <br /> Address: 1 <br /> -1 1 City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: t �2 Progra ocord: \-i 2 \ CI Inspection Type: <br /> 6180 Posted Yes No Permit Posted Yes No V Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 5 <br /> Z _ e�siO l0 3 <br /> 3 - i� l �( - •, t <br /> S S` , <br /> vJ i <br /> o-/ -fes 2.0 01 CAI--O— Ct <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Rt gitd�� and Sink: eF hlorine: PPM eat: >F <br /> Exp.Date: "' / arewashing Sink: 'F uat.Amm.: PPM ther: 'F <br /> Received By/Title: <br /> EH Specialist: Phone: `-A1V_ —�p <br /> Time in: 'S ' C— <br /> S Time Out: � 2 J Pag Of i <br /> EHD 16-24 (2i°pg) 4013 Jll FOOD PROGRAM OIR CONTINUATION <br /> �0 ,yO - (Z-0 ✓ b'. ySr,N <br />