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SAN JOAQUIN COUNT°/ <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.s6gov.org/ehd <br /> tl�bd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: / Date: - Z 0 <br /> 10/ <br /> ddress: • A, City: /� n< Zip Code: <br /> OwnerlOperat r: Telephone: <br /> Program <br /> Program Element: Program Record:`-"-' O-f� Inspection Type: , <br /> 8180 Posted ❑Yes ❑ No Per Posted ❑Yes ❑No C Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> l1,zy eA14_ 141vt qhQ v qiY/ <br /> .kl ' t G A�'l C of <br /> e -71 n q/Y! �ai <br /> Q <br /> ✓ ! l�I 6f/Y� / ' 7U <br /> f - <br /> r �%diyt, r iD r <br /> vt/ C� l'�'J • Ntanq 11474 AV <br /> „ 1 <br /> u �S�l2t X� <br /> w <br /> G <br /> Item/Location Temperature Item I Location Temperature Item I Location I Temperature <br /> , <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: .F hlorine:• ppm eat: `F <br /> Exp.Date: arewashing Sink: .F uat.Amm.: ppm ther: .F <br /> Received By I Title: a <br /> EH Specialist: Phone: <br /> ime in:IT r Time Out: Page of <br /> EHD 16.23(2°pg) I1/eM F60D OIR CONTINUATION <br />