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SAN JOAQUIN COU Y <br /> ?a ENVIRONMENTAL HEALTH DEPARTMENT <br /> N: :< <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax.(209)464-0138 Web:www.smqov,org/ehd <br /> {t�o� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: a w0. Date: D 1q -f3 <br /> Address: U"Ily City: ���L� �y l Zip Code: dy <br /> Owner/Operator: Telephone. 4Y <br /> �.o Ib.Cr�" g t�S T <br /> Program Element: Program Record: Inspection Type: <br /> 1l.0o COO 710 <br /> S13i8o Posted es �7 No Permit Posted !-Yes ❑ No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> �- <br /> n o f of 4 f <br /> are- G <br /> rrr o� C-lea <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: aF <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> f <br /> EH Specialist: ` / Phone: <br /> Time in: Time Out: O�{3Q 4 Page ,of , <br /> . � t <br /> EHD 16-24 {2^1 pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />