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aP4"'"• SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />ai <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br />�IFOe� <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />r Date: �� 2 Z <br />Address:/1& <br />1 <br />it <br />City: Zip Code: <br />Wail <br />Owner/Operator: �r <br />Telephone:,q <br />Program Element: 16 <br />Program Record: , 12. , Inspection Type: <br />SB180 Posted Yes No <br />Permit Posted Yes No 1 Re -Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />r <br />r <br />010 fes • <br />roor <br />gek S< <br />t <br />i <br />19kd J4 /a <br />� <br />� C <br />C <br />ItamlCocation `, <br />_ <br />Temperature • -' - Item/Location -`, ,`Temperature <br />n <br />w iaJii4 <br />rwf <br />_,F,00d Safety. Certification. _ <br />Name: LAA104 Y,�� <br />Facility Hot Water Temperature _ Warewashing <br />Hand Sink: i ,L�- OF Chlorine: ppm Heat: <br />oF, <br />Exp. Date: 6 -2�1 , <br />2_0 2 6 / <br />arewashing Sink: 0 OF Quat. Amm.: ppm Other: <br />eF <br />Received By / Title: <br />- <br />v '7 `I l 0 O/ r 1 11 Z 9 Z Li <br />EH Specialist: r <br />• F <br />Phone: Mf <br />vrI n _ <br />ime in: "wk— <br />Time Out: , —! <br />Page of <br />EHD 16-24 (2' pg) 413/13 <br />FOOD PROGRAM OR CONTINUATION <br />S <br />ro <br />