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oP4N'" SAN JOAQUIN COLI* <br /> b' <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ... p. Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.siclov.oro/ehd <br /> °cik6'Ad: <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: I - Date: S <br /> Address: 5�14' 5 G City: Zip Code: <br /> Owner/Operator: ,„e,1„' J.. Telephone: <br /> Program Element: I� b a` Program Record: S fz&VV 71 <br /> 53T Inspection Type: <br /> 8180 Posted 0 Yes 0 Rerrnit Posted O Yes 01 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> G L <br /> IA) o <br /> ✓t.a ez v4-i�i� � a c/Car� <br /> 0 r /YlAvla / Inc <br /> l (cu- <br /> ItieU f' � G- ✓ ✓ <br /> 1 Item/Location Temperature Item I Location Temperature <br /> u�in— I iwashl?-- 35F <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: owP7and Sink: /ffl eF hlorine: ppm eat: eF <br /> Exp.Date: <br /> 0-v <br /> 1 A arewashing Sink: rVL-L of uat.Amm.: ppm ther: .F <br /> Received By/Title: " <br /> EH Specialist: Phone: GL' <br /> Time in: 1 Time Out: 2 J Page• f <br /> EHD 1624 (2-pg) 4/3113 J FOOD PROGRAM OR CONTINUATION <br />