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�"`�'n •s SAN JOAQUIN COUNTY <br /> A ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> a'tl�ew�';a Telephone:(209)468-3420 Fax: (209)464-0138 Web:www.s'gov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 1 Date: b_ I y_ Z <br /> Address: 2y —A o <br /> City: Zip Code: to S Zo <br /> kn <br /> OwnerlOperator: Telephone: 3_7 F, 90 2 <br /> Program Element: '1,..x.3 Program Record: O I Inspection Type: <br /> SB180 Posted Yes `V No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> S <br /> LAJ� 42 <br /> (2v. o <br /> 1 h <br /> ,2 <br /> rAJE--� <br /> -4- <br /> Q� <br /> . o <br /> 'Temperefura "' '`` `' Itemltocation jB <br /> — ZcI — <br /> 1�3� <br /> F od Safety Certification_ Facility Hot Water Temperature <br /> Name: - Hand Sink: of Chlorine: ppm Heat: of <br /> Exp. Date Warawashing Sink: 2 2 of Quat Amm.: ppm Other: eF <br /> Received By I Title: 3 7��3zS <br /> EH Specialist: Phone- (Q <br /> b— <br /> me in: Time Out: 1 ��1 Page of <br /> EHD 1624 (2m pg) 413113 FOOD PROGRAM OIR CONTINUATION <br /> pRUS�Pta�tKS <br />