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'q.PpHlry,..c�G SAN JOAOUIN COUNTY <br />Q` a ENVIRONMENTAL HEALTH DEPARTMENT <br />a: :< <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />84YI o �;P Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sioov.oro/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />A. <br />10 S 1 <br />'- Date: <br />Address: I J L' <br />�-7 <br />�C <br />City: /� "Pp Code: <br />Owner/Operator: <br />Telephone: <br />Program Element • <br />62 L Program Record: <br />4 10 <br />Inspection Type: <br />1 <br />SB180 Posted Yes <br />No Permit Posted Yes No <br />Re-Inspectlon on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />07 d,'qf <br />/rte <br />Ve- <br />a l <br />�6 <br />- <br />C� i <br />o <br />CIO vtAp <br />J7V!il/o <br />C <br />f! Lis 1 <br />Iteih%Loeation->T' <br />Temperature <br />Item / Locatlon Temperature <br />Food Safety Certification <br />Facility Hot Water Temperature Warewashing <br />Name: <br />Hand Sink: <br />"F [Chlorine: ppm Heat: -F <br />Exp. Date: <br />erewashing Sink: <br />.F uat. Amm.: ppm Other: of <br />Received By/Title: <br />EH Specialist: <br />-� <br />Phone: <br />Time In: I Z -,--3 <br />J OM <br />Time Out: ,2 Page of -Z <br />EHD 16-24 (?-pg) 4013 FOOD PROGRAM OR CONTINUATION <br />