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SAN JOAQUIN COUIO <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton,.CA 95205-6232 <br /> `4�IFaaN;p Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: s Q�r # ' Date: 62 <br /> Address: y — M'04 <br /> L City: Zip Code: 2 O <br /> OwnerlOperator: DI-no r .a5 Tele o e' —2Z7— <br /> Program Element: ` f0 33 Program Record: Pp Inspection Type: Oct <br /> 8180 Posted O Yes Kermit Posted v es /❑I Re-Inspection on or Aller: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 1at Y-+ %k-L Y-m��i 0>1 :feLA o -F- <br /> ro CAJe c Dn ea ►- a »tie__ 00 2 t nz s - e�-l- <br /> �� Lv, o" P5 ��—I-sS�_�--I��C o <br /> z <br /> �} rr C <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification f=acility Hot Water Temperature Warewashing <br /> Name: and Sink: T I (D(D .F Chlorine: ppm Heat: `F <br /> Exp.Date: arewashing Sink: 'F uat.Amm.: ppm ther: "F <br /> Received By I Title: Q Y_n, wde3 <br /> a <br /> EH Specialist: M f�•c,.J�• U 6J1.4'L!E Phone: 6 <br /> Time in: L Time Out: fJ ;OD O Page-;f-1 <br /> END 16-24 (2°pg) 0113 FOOD PROGRAM OR CONTINUATION <br />