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o.Pa"'"• SAN JOAQUIN COU( r <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sioov.org/ehd <br /> �lcb'A <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: # Date: _a/ <br /> Address: r O r City: �O G li� Zip Code: .$'2 OS <br /> Owner/Operator: rP7 n Or -e !� Telephone: a3 _9—I lL <br /> Q <br /> Program Element: (0 3 C/ Program Record: P V h 5 LY '5 Inspection Type: b u'71/ ' 7 <br /> 8180 Poste�Yes No Permit PostedVXes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> �'► i6Y c v a <br /> 20 Q 1 a 4a 4-7' 027 <br /> 0 -x C.SS r r <br /> Hem/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: and Sink: eF Chlorine: ppm Heat: >F <br /> Exp.Date: arewashing Sink: of Dust.Amm.: ppm Other: eF <br /> Received By/Title: f7 <br /> EH Specialist: Phone: <br /> Time in: I 'r OU Time Out: J� ,! S/O Page/of <br /> EHD 1624 (2^pg) 41YI3 v / FOOD PROGRAM OR CONTINUATION <br />