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FqU�" SAN JOAOUIN COUNTY - 1h 'TC <br /> ZX ENVIRONMENTAL HEALTH DEPARTMENT <br /> �� �r >,1868 East Hazelton Avenue, Stockton, CA 95205-6232 P <br /> c-.. ;i ne:(209) 468-3420 Fax:(209)464-0138 Web:wu`w.sigov.org hd <br /> 4`,FOR� m � <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: b Date: <br /> - <br /> Address: S 2 1 City: zip Code: c.-1 S 2- <br /> �t U <br /> Owner/Operator: W rt Telephone: c <br /> Program Element: 1 �tc� Program Record: ZC,7 Inspection Type: r� <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATION AND:CORRECTIVE AC TIONS - =_ <br /> -L <br /> 1 <br /> 11e".,r�c.1 <br /> n - _.._ .___C1Q_�C1-._ w .__s2G __ �_.__.IL .SL . <br /> C_\ c; <br /> "" 1 n S J� -I .'��� c-� :•4-�.;��-� - 1. � -. <br /> .01 <br /> Item/Location a6miietatdireV t Item/Location Temperature <br /> •r' I � — �f-o•'iiU� 5-� - iZQ C%o � 3�1 1 <br /> Food Safety ertification Facilit Hot Water Temperature <br /> Warewashin <br /> Name: Hand Sink: , 1 ` -F Chlorine: PPM Heat: `F <br /> Exp.Date: Warewashing Sink: 'F Ouat.Amm.: Ppm Other: 'F <br /> Received By/Title: <br /> EH Specialist: Phone: b ta.. 7,r <br /> Time in: Time Out: i ` Page of <br /> EHD 16-24 (2n4 pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />