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oPR�In•.c SAN JOAQUIN COUNTY <br />2' 1 ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />r... P Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br />,CIFd R� <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: e <br />Q <br />Date: <br />Address: /V H461y <br />Z� er/ <br />City: <br />Zip Code: /� D <br />Owner/Operator: <br />Telephone: <br />Program Element: a Program Record: O S� <br />_ I <br />Inspection Type: LL <br />B18O Posted Yes No Permit Posted es No <br />Re -Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />- <br />d 5 o o G►/J 1& Cel4� <br />Z2101 <br />-i We <br />v D <br />Q <br />Fe <br />8� 5 � o . • <br />r Zvi Ge /' <br />CBi" <br />llvrfq/ei2 <br />C 9 <br />`ti l� Ln ✓�l <br />JJ <br />o <br />''•1' Itlten/LocatlLtiom,- <br />.. S L 2kl � T1 <br />Temperature <br />S <br />Item/Location <br />Temperature' <br />� <br />ysF <br />Food Safety Certification <br />Facility Hot Water Temperature ift. <br />Warewashing <br />Name: <br />Hand Sink: <br />'F Chlorine: <br />PPM Heat: <br />'F <br />Exp. D e:arewashing <br />Sink: <br />"F uat. Amm.: <br />PPM ther: <br />of <br />Received By/Title: <br />D;,5 L <br />f/ A, <br />EH Specialist: l - - <br />'-� <br />Phone: (,� l6 r.�(� 3 <br />S -- <br />Time In: ,. O PM <br />Time Out: - <br />- <br />Page of <br />EHD 1624 (2 -pg) 4/d1i3 FOOD PROGRAM OIR CONTINUAnON <br />