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SAN .JOAQUIN COUNT <br /> ENVIRONMENTAL HEALTH DEPARTMENT /j,- I <br /> " Dc 1 M I~ <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 r <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.si_qov.org/ehd <br /> dI�CW`' <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: C^ �LjK9Date: <br /> ddress: 55 City: Zip Code: <br /> OwnerlOperator: Telephone: f� <br /> Program Element: Program Record: f7 O I Inspection Type: rit <br /> o <br /> 6t 80 Posted D Yes O Remit Posted !- O Yes Of Re-Inspection on or Aker: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> li 1 <br /> •. r <br /> r <br /> J <br /> 's M / r <br /> Item/Location Temperature - Item 1 Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: and Sink: 'F hlorine: Ppm eat: 'F <br /> Exp.Date: arewashing Sink: `F uat.Amm.: ppm Cher: 'F <br /> eceived By/Title: /� �� <br /> EH Specialist: 6/ Phone: �.5 <br /> ime in: Time Out: ?��'•rPage of <br /> EHD 16-36 (2i°pg) 413/73 •.7 J FOOD PROGRAM,OR CONTINUATION <br />