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PQu�" SAN JOAQUIN COUNTY <br /> Q` ENVIRONMENTAL HEALTH DEPARTMENT <br /> N: X <br /> _ = 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> cq.. iP Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 01V",L& A'nllDate: a� <br /> Address: v /j/ A City: Zip Code: ��/_ <br /> Owner/Operator: �'v Telephone:C/ /E'/�, <br /> Program Element: ' 35Prog am Record:40-1\ �S / Q Inspection Type:o �G <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> oki-e slew <br /> a <br /> dA 1A)AS <br /> Item/Location Temperature Item 1 Location Temperature <br /> Ony _ - - -- <br /> Food Safety Certificatio Facility Hot Water Temperature Warewashing <br /> Name: �h m Hand Sink: / / n OF Chlorine. ppm Heat: OF <br /> Exp.Date: Z arewashing Sink:/���-1 i� of Quat.Amm.: ppm Other: OF <br /> I— MU22 <br /> Received By/Tit e: <br /> EH Specialist: Phone: — d <br /> Time in: Time Out: Page of/ <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />