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�oP4"I" SAN JOAQUIN COUNTY <br /> . .-oo <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �q. N;P Telephone:(209)468-3420 Fax: (209)464-0138 Web:WWW.sigov.orq/ehd <br /> L�Poft <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Y a _.\_ V Date: ±_ i21 <br /> Address: 2 , City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: `16 pl Program Record: S�{ 2 �(O Inspection Type: T <br /> SB180 Posted Yes No Permit Posted Yes No J U Re-Inspection on or After: <br /> - _ <br /> OBSERVATIONS AND CORRECTIVE ACTIONS xxsp <br /> C <br /> 3r <br /> lOR) <br /> A <br /> Q <br /> t <br /> Item/Location Temperature Item/Location Temperature <br /> _ food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of uat.Amm.: ppm Other: of <br /> Received By/Title: e <br /> EH Specialist: Phone: b I - 3n2--s- <br /> Time in: Time Out: :Paq:e_,Pf <br /> EHD 16-24 (21d pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />