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r ` • �,47bu R�'`p <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.sigov.org/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />Date: <br />Address: <br />City: Zip Code: <br />Owner/Operator: <br />Telephone: <br />Program Element: Program Record: <br />Inspection Type: <br />BI80 Posted Yes No Permit Posted <br />Yes No <br />Re -Inspection on or After: d 1'-2 0rL 3 <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />3�= t . A Ljn2 <br />-r W AT450- <br />is N col- A -A 1 LAg Lc--, wr p <br />iq c-+ <br />I -t <br />W I rN I N <br />1-1,4S N jE t-1 U I? T17-hf <br />Mf <br />�bo <br />o <br />V f <br />13. O V IP <br />G L I I Lb V <br />P <br />Item/Location j. _.. <br />-- <br />Temperature <br />,,,,,w Ifeml Location <br />Temperature:, <br />�voaw <br />- <br />v I- 2 �O <br />1 Nt�RlJA716N g� o -. 2�-?� <br />W ALK —1 N coot rcR 4040 <br />Food Safety Certification _ Fac111ty Hot Water Temperature ;.� Warewashing <br />Name: rJ ^ Hand Sink: aF Chlorine: PPM Meat: <br />J-F <br />Exp. Date: arewashing Sink: <br />'F uat. Amm.: Ppm <br />Other: <br />Received By/ Title: <br />EH Specialist: L <br />Phone: <br />ime in: I D; 97 A n4 <br />Time Out: P A &I <br />Pagtof 2 <br />EHD 1624 (2m pg) 43113 FOOD PROGRAM OIR CONTINUATION <br />