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aP"'"'"• SAN JOAQUIN COUNTY <br /> a ENVIRONMENTAL HEALTH DEPARTMENT <br /> e: :K <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • c°q.,,, :t'P. Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.siaov.oro/ehd <br /> AladaV' <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 5� ' Date: Lk — I — 2 2 <br /> ddreas: 15 1 b S ' 4C�� k C,"(� 12cLcity: c� � Zip Code: q S 33r <br /> Owner/Operator: �2.h ✓ Telephone: <br /> Program Element: Program Record: 3 2 (o -� Inspection Type: S <br /> SB180 Posted Yes No Permit Posted Yes No V Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Y \ <br /> e r t re <br /> s1 n <br /> i b l <br /> c.� <br /> r-c) <br /> A • <br /> 9 o - 61b 2 <br /> Item/Location 'Temperature Item l Location -7 FTemperature <br /> Food Safety Certification Facility Ho_t.Wate_r Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: 'F <br /> Exp. Date: arewashing Sink: of uat.Amm.: ppm ther: OF <br /> I <br /> eceived By/Title: �: , �,H Specialls • w� Phone: 2 o�_ t_O 1 _ �O 2 <br /> !me in: t?\ Time Out: t 2' Page of <br /> EHD16.24 (2"po 413113 1 FOOD PROGRAM OIR CONTINUATION <br /> S <br />