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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.sigov.org/ehd <br />cifsp"a�' <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />(J <br />Date: 11,312-673 <br />Address: <br />VL1 <br />l/ <br />City: <br />Zip Code: <br />caner/Oper tor: <br />��� <br />t <br />Telephone: <br />Program Element: luw <br />Program Record: 01 R <br />Inspection Type:I_ <br />p <br />B1 BO Posted <br />s 11Rennit Posted es I <br />Re -Inspection on or After: <br />�`i•-�- <br />�}�� <br />..�,, �� t. <br />OBSERVATIONS AND CORRECT,tY 121ims <br />.r c�' >. �<<:.�� 6-f✓ (T Gt <br />�5r <br />✓4— <br />F <br />rCQ4Lit rle_ <br />alp <br />Yw <br />+vLt <br />l-- <br />w <br />c 0 <br />l viyt� <br />oqi 4(41-Ov <br />v emwWym <br />vvuktd, rtt tir,w � � t, w <br />:Food Safety -Certification <br />Name: <br />Exp. Date: <br />m/Location """ Temperatuie.: <br />Facility Hot Water Temperature Warewashmg <br />Hand Sink: of Chlorine: ppm Heat of <br />arewashing Sink: oP Quat. Amm.: ppm they: >F <br />Received By I Title: <br />e <br />EH Specialist: <br />Phone: <br />I! <br />ime in: <br />Time Out: 3 <br />Page of <br />EHD 16-24 (20° pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />