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C9Crp0p�(Po.04V1t! c <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sioov.ora/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: FiL7 <br />Date: 0 O Z <br />Address: City: <br />Zip Code: <br />Owner/Operator: <br />Telephone: <br />Program Element: Program Record: <br />Inspection Type: <br />Bt 80 Posted Yes No Permit Posted Yes No <br />Re -Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />I g' 1012" N L <br />L <br />Q it / 2/ <br />blvy�. <br />F S N T <br />LL <br />fel V'j 92n5 ON — / e <br />! U M 41M 4,*Ir <br />• a r YO -1,60 P14" w <br />o <br />O!? A <br />Item/Location Temperature �� <br />O"C-- A2 P:04f�L 60o4ae — 3-9/e G U r- <br />n! c 6 — GootER I L0 9- . <br />Y __ Facility P <br />Name; Food Safety Certification 'Hand Sink; Hot Water Temperature <br />�_ QVQ / p �_ _OD <br />ALONG ! <br />Exp. Date: 0 2 — 22^'2 3 Warewashing Sink: ,z / <br />Item/Location ( Temperature" <br />A4671 tAt _ t=ni IY roc D_cvoLIRZ <br />�Ir Warewashing T -_-- — <br />Chlorine: shin .. <br />F l 60O PPM F <br />-F Ouat. Amm.: ppm Other: �F <br />Received By/ Title: <br />EH Specialist: C 4-A 4 t o �� <br />22 O 2 <br />Phone: Za _ 51 JOY. <br />Time in: /1110 <br />• 0 / Pm <br />Time Out: ?/ P Pelt of <br />EHD 16-24 (2n°pg) 4313 FOOD PROGRAM OIR CONTINUATION <br />