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1e_ SAN JOAQUIN COU> I�.•' '0G <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> -__ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> LIRORIa <br /> Telephone:(209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: F - - 3 Date: <br /> -L <br /> Address: City: Zip Code: <br /> Owner/Operator: ,C Telephone: <br /> Program Element: 1 Q S Program Record: S Z Inspection Type: <br /> r§_1 8-1) <br /> Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> :% OBSERVATIONS AND CORRECTWE ACTIONS <br /> Q V cam" CJ`/L1L--ti <br /> 1, 11 4 <br /> we •. 115 ^ - <br /> U cv,t <br /> J2 <br /> Soo C <br /> OF <br /> Item/Location : Temperature ;� Item I Location v Temperature <br /> 13 1 1 L <br /> \F7� " <br /> Food Safety Certification Facility Hat Water Temperature Warewashing <br /> Name: (Hand Sink: ��F Chlorine: ppm Heat: °F <br /> Exp.Date: warewashing Sink: of IIQuat.Amm.: ppm Other: �F <br /> Received By/Title: <br /> EH Specialist: Phone: b <br /> Time in: Time Out, Page of <br /> EFD 1&24 (2-pg) 41T13 FOOD PROGRAM OIR CONTINUATION <br />