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SAN JOAQUIN COUN' <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East HazeIton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.splov.orq/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: Date: <br />Zip Code: 4.-2 7 S 27.0 7 Cit / ‘s-2. 56- froyD tit Z.,,V <br />y: <br />5 Owner/Operator: , Telephone: <br />/ 1 ib, j iotp ye 2 ci Program Record: <br />SB180 Posted No Permit Posted Ves No Re-Inspection on or After: <br />Address: <br />Program Element: Inspection Type: <br />701‘2, q3 STj <br />ieva <br />OBSERVATIONS AND CORRECTIVEA.crigNs <br />p'-etekeA‘r 41-tiviy tAt.7,e/ eo_.0 <br />‘0-6thinA--S <br />kok w 4 (44 <br />Item / Location Temperature Temperature <br />Facility Hot Water Temperature Warewashing Safety Certification <br />Name: Hand Sink: °F Chlorine: PPm Heat: °F <br />Exp. Date: Warewashing Sink: Quat. Amm.: PPm Other: <br />Received By / Title: <br />EH Specialist: <br />/A-A-4.4-t <br />/0 /30 <br />Phone: <br /> <br />Time Out: Page of Time in: /8,' 41r <br />FOOD PROGRAM OIR CONTINUATION EHD 16-24 (2w pg) 4/3/13