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SAN JOAQUIN COU. 1f <br /> 2r ENVIRONMENTAL HEALTH DEPARTMENT <br /> P: A <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Kj...., 5.. > Telephone:(209) 468-3420 Fax: (209)464-0138 Web:www.s'gov.org/ehd <br /> c1ndA� <br /> F OD PROI(IRMA OFICIAk4INSPECT ON REPORT <br /> Name of Facility: Date: <br /> Address: , >City: t� ff-yZip Code: <br /> Owner/Operator: r I r n Telephone: � 90 — / �r <br /> Program Element: l^'� Program Record: Inspection Type: <br /> _ �7 <br /> SB180 Posted Y No Permit PostedRe-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> a e -+,5I <br /> W <br /> r p r A ots <br /> t-1 <br /> 116 <br /> ' � �Nl.�r 641- <br /> " <br /> s Cl, <br /> �n� r <br /> t A) L <br /> o� off_ sL tC2SS`��. v6_1 <br /> a I . �+ O 'L <br /> hem/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Wa er Temperature Warewashing <br /> Name: nCI n. � Hand Sink: ,F hlorine: ,n0 ppm eat: ,F <br /> Exp.Date:!'1!-i l..A arewashing Sin eF uat.Amm.: f,� Ppm ther: eF <br /> Received By/Title: <br /> EH Specialist: _ Phone: <br /> Time in: Time Out: Page of <br /> EHD 1624 (2^ pg) 4013 FOOD PROGRAM OIR CONTINUATION <br />