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SAN JOAQUIN COLIN _ <br /> :< <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> UX <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax: (209) 464-0138 Web:www.segov.org/ehd <br /> <iFORN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 1 7 Date: <br /> t. 4- l c �' c r C) /Y' <br /> Address: 5 L City: ��� Zip Code: 9s3Gy <br /> Owner/Operator: Telephone: K'?6�3y6 <br /> Program Element: Program Record: Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Cu 05 On 1he aor C c i rec I,-/. <br /> SIF, I r if e G, k s cI A d S c, s h 4 A d W n. l: <br /> LA len3;Is ;a re Ven f hwrrl;Ac'1; o .-C-1 <br /> 3 P. u w ru 'Iin inirl u G � �3o'Freceived) <br /> P! i G 4 G VG C criecj G <br /> Item/Location Temperature Item/Location Temperature- <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: �A SS C V Hand Sink: CJi of Chlorine: ppm Heat: F <br /> Exp.Date: p I/ Y Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: / <br /> EH Specialist: Phone: <br /> Time in: /D-�, Time Out: /( Page of <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />