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a°'"• SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />cy .rFaaa a• Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www,sigov.orci/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />me of Faciltty: <br />o �2/,, <br />Date: <br />.Z <br />dress: <br />City: <br />o <br />Zipod:ner/Ope <br />tor: <br />l,r,l <br />Telephone: <br />gram Element: 1 <br />Program Record: O I <br />inspection <br />Type: <br />to —/,N S [180 <br />Posted Yes/ <br />No <br />Permit Posted Yes No <br />Re -Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />Ift <br />Ob <br />e u.,` Id a <br />()In <br />Aoa4 <br />rr/w <br />a <br />7 r/ e {/ n <br />d^Q k <br />Lrifz Lvt <br />h6- <br />5 <br />2A7 ec 400 Z4 l <br />0115+' <br />h; <br />ri 0-cv <br />Z�� <br />S k <br />Item/Localion <br />Temperature <br />Item l Location <br />Temperature <br />Food Safety Certification Facility Hot Water Temperature <br />warewashing <br />Name: vuee <br />Hand Sink: <br />OF [Chlorine: <br />ppm Heat: <br />J'FExp. <br />Date: <br />arewashing Sink: <br />.F uat. Amm.: <br />ppm her: <br />Received By /Title: <br />t S f w S -2 J <br />e 1c <br />.� <br />EH Speclallst: <br />J, <br />Phone: <br />Time in: <br />Time Out: z <br />Z Page <br />of <br />EHD 16-24 (200 pg) 4W3 FOOD PROGRAM OIR CONTINUATION <br />