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SAN JOAQUIN COU <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> c4..•. • ..;a Telephone:(209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> c,FdA`' <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: �Y a» Date: 3 3 <br /> Address: G' City: Zip Code: <br /> Owner/Operator. 4..TTelephone: <br /> Program Element• /6)� Program Record: 0 1w l39 Inspection Type: <br /> 8180 Posted 0 Yes D Remit Posted V JD Yes ❑1 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> if Cly <br /> c ' <br /> D ✓W ✓ 011 k (Sj kA ti�VU , tf �-ap /.I Vh lT -VW al GGrnq-jg!ti <br /> a U33 <br /> D t fw 1 P <br /> Item/Location Temperature r " Item/Location Temperature <br /> Food Safety Certification _ ' 'Facility Hot Water Temperature - Warewashing <br /> Name: IM(�� and Sink: ,F hlorine: ppm eat: IF <br /> Exp.Date: 02 arewashing Sink: <F uat.Amm.: ppm ther: <br /> Received By ITitle: HC( � <br /> H Specialist: Phone: — <br /> ime in: I o Time Out: Pag ofL, <br /> EHD 1624(2°Pg) 4013 V FOOD PROGRAM OR CONTINUATION <br />