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Pqu�" SAN JOAQUIN CO. XY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ - Y. 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.slgov.org/ehd <br /> �tFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: U `N-. Cwov_ 1?- Date: qIs-/ I-+ <br /> Address: `uc* #'Ti4e ��1 *4af '�CA <br /> City: �1 .a�1 Zip Code: P05� <br /> Owner/Operator: \1 1v'_ 1\691C �n Ui_ Telephone: 12 -1 <br /> Program Element: 1 Program Record: R0P52 Inspection Type:� Q.4 <br /> Q e \�_ <br /> SB180 Posted Yes No Permit Posted Yes No U Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> i ITO <br /> cam- CC CA_Z tA sc `sj ire - <br /> - in <br /> - -- CA+Oe G"A_ r0\0, <br /> - 0 - <br /> oQ'-s C44ee ,. <br /> t i c� hG u11 rM�f wi1�h �Tl't� u <br /> aKx- r)a w tX1. Cant c�ecl <br /> Q)mC keAr,C ace Qvned <br /> r( Tr <br /> - - <br /> %:?m/L ocatton Teinperatura Item/Location Temperat <br /> i <br /> i <br /> i <br /> — ciadSafet}+Certification — - E tz ttytf t mp Ware as <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> -- - <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: Time Out: tom'\ Page f <br /> EHD 16-24 (2n°pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />