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P l c%e l(- <br /> SAN JOAQUIN COUN1 T r <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 /> <<FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: a a +c r City: StbZip Code: el 5 <br /> Owner/Operator: W pid$ r Telephone:NO <br /> F 3X35 <br /> Program Element: 11_D� Program-Record: O 59 3 20 2Inspection Type:, <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> e c <br /> Ib) n ` r0 yj S <br /> 11at F <br /> . I� <br /> i z ` n con 7ax <br /> O' <br /> Lf- <br /> 5 poemyr, m4^ uAri <br /> C-mil c-L":',1.7 ACL6.1 I o- c-- 1 o <br /> Item/Location Temperature . Item/Location Temperature <br /> io PIT!! V�O I r , <br /> r V- 32 Or- <br /> Orr_,4 <br /> Food SaAty Certification Facility Hot Water Temperature Warewash'ing - <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: t Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: h Time Out: Page of <br /> V,b® <br /> EHD 16-24 (211 pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />