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4 '"• SAN JOAQUIN COUNTY <br />_ ? ENVIRONMENTAL HEALTH DEPARTMENT <br />Q: a <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />a.. Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.s*gov.org/ehd <br />9�%F (iM1N\P <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: 1'Date:2 <br />Z'a <br />ddress: <br />City: 6 21p Code: <br />Owner/Operator: <br />Telephone: <br />Program Element: 16 �2_ <br />Program Record: -D s 2 Inspection Type: <br />SB180 Posted Yes NO Permit Poste "Yes No Re -Inspection on or After: <br />:7z L3 <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />Gt- <br />� <br />10 0- <br />d -L <br />S oti d S kk1_14 <br />2 rn t. <br />t-7 loam <br />O <br />S <br />A O <br />Dom. ib <br />l'� <br />3 -F, <br />�e' <br />K <br />P <br />KV - to <br />p <br />D - <br />ere <br />6 ; K'7 <br />y <br />- S -f <br />o/Z"�/t _ <br />Item/Location <br />Temperature Item/ ocation <br />Temperature <br />/ mak <br />-i Oa F <br />- <br />S40113 <br />-1 )9 2 'dike A <br />r— <br />rvlea <br />1 G S F e <br />_MFSF 7 /~-� <br />36 <br />Food Safety Certificat on <br />Facility Hot Water Temperature Warewashing <br />Name: - f, L Hand Sink: <br />of hlorine: ppm Heat: <br />,F <br />Exp. Date: 30 ��2 s <br />arewashing Slnk: I a ® 'F uat. A 00ppm ther: of <br />tle: S <br />% _� <br />0 <br />E <br />U Phone: <br />b <br />fyqM <br />Time Out: ' : <br />Page of <br />EHD 16-24 (2n° pg) 4tN13 <br />