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SAN JOAQUIN COUP <br /> mENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> c� �v• Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ' . o ISro Date: <br /> Address: , i ' I So a City: �n Zip Code: <br /> O t e <br /> Owner/Operator: Si U { m a C Telephone• weso (4I0~LI;13 <br /> Program Element: {_ Program Record: a Inspection Type: <br /> VB Posted es No Permit Posted Yes o Re-Inspection on or After: <br /> r' 1, OBSERVATIONS AND CORRECTIVE ACTIONS <br /> in, r n'Li4 i.S rti o-k -ti-c l.t` a u cu <br /> PA A- a-Lel 4-5 �'Y►f� — <br /> L,L n U n a n <br /> Gp % Ir rru <br /> cis - L:P4 p a cg <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: "F Chlorine: PPMeat: "F <br /> Exp.Date: Warewashing Sink: "F uat.Amm.: ppm ther: "F <br /> Received By/Title: 9E ,jVt0% d d ' <br /> H Specialist: Phone: Q`L _ n <br /> Time in: Time Out: , O / Page of <br /> L <br /> co: <br /> EHD 16.24 (2"d pg) 413x13 FOOD PROGRAM OIR CONTINUATION <br />