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apo"I" SAN JOAQUIN COUIS <br /> r. < <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • c.. �• Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sioov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Q 4- n S ��✓S # �, Date: <br /> Address: qLqq u.) �'r�srt e�h 1 City: G Zip Code: 20 Z <br /> Owner/Operator: Forla cJ Telepho Q _ Zu <br /> Program Element: -z S2 Program Record: n O 5 O Inspection Type: ZZO" 'A-L� <br /> 8t 80 Posted ❑Yes O Rermit Posted n ❑Yes ❑1 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> no + l.�l C� 5 e 0 1*0 L">L 0�" <br /> Qj <br /> Item/Location Temperature Item I Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: and Sink: "F hlorine: ppm Heat: 'F <br /> Exp. Date: arewashing Sink: `F uat.Amm.: ppm Other: F <br /> Received By I Title: MAY YQ <br /> EH Specialist: - 'I Phone: <br /> Time in: �D Time Out: r I PageZf 2— <br /> EHD16.24 (2-pg) 413/13 FOOD PROGRAM OR CONTINUATION <br />