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ohs"'"• SAN JOAQUIN COUNTY <br />t: �a•Fac <br />�+ ENVIRONMENTAL HEALTH DEPARTMENT <br />a:. < <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />aai/Fo'aa;a Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.s' ov.or 1ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: 1 U <br />- - � <br />Date: I <br />- I V .- Z <br />Address: 3 2 O <br />1 <br />�0 <br />City: <br />- I \ C `. Zip Code: Cl S 3C)caner/Operator: <br />-­S� 3S e <br />Telephone: <br />Program Element: 1 b 1 3 I <br />Program Record: 5 2_12)0'_K:2, <br />Inspection Type: <br />B180 Posted es No <br />Permit Posted Yes No <br />Re -Inspection on or After: <br />SANDCQR ECTI E ACTIQN§ <br />d � <br />1 <br />I <br />2 u <br />ItemlLocatigl._ <br />item /'Loco o <br />\ <br />�•l l <br />Ereez-o^, 11 F <br />Food Safe C <br />Safety y <br />_cility Hot Water <br />Temperature <br />Warewashing,- <br />Name: 5 <br />Sink: , oQ <br />5 <br />'F <br />hlorine: ppm <br />Heat: <br />=F <br />Exp. Date: _ I O _ 2 <br />_AVNcand <br />arewashing Sink: <br />3 <br />of <br />Ouat. Amm.: Ppm <br />Other: <br />=F <br />Received By/ Title: <br />Q <br />12h <br />5 <br />EH Specialist: <br />C <br />- 1 _ <br />V\ <br />Phone: iL 1 , ^ 1 I <br />V �O <br />3 0 Z +� <br />Time in: \ -, 0 <br />Time Out: 2 33 42 <br />Page of <br />EHD 16-24 (21° pg) 4/3,173 1 1 FOOD PROGRAM OIR CONTINUATION <br />