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SAN JOAQUIN COON" <br /> y ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax: (209) 464-0138 Web:www.sbov.ora/ehd <br /> L�FORN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: <br /> W 1 oo Date; <br /> Address: Cit _ �-� ` <br /> f C7 t{ {` y S C"ave Zip Code: `i'5-2 r <br /> Owner/Operator f Telephone: <br /> Program Element: t+& Program Record: �D 00 3- Inspection Type; <br /> CIL3 211, Cc V.".4- <br /> 58180 Posted L]Yes -1 No Permit Posted ❑Yes ❑No Re-Inspection on or After: <br /> 1 _ OBSERVATIONS AND CORRECTIVE ACTIONS <br /> L cK 0.1 K 5' S rt <br /> r t, f` c' r►�fi� �`Y�.S j I'►t � <br /> t r 5 <br /> 1—_"'_"U( <br /> Rev w 14 e, f I kz ork—Qr- <br /> o arc d, ca rn 15 G V c.�! !4 b�� r Lrz��. GN PrS r <br /> — � -. }} <br /> r.% +rla 'h 0. CCi I-L rCL Kp ix <br /> 1;'tct ( <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 Quat. Amm.: ppm Other: of <br /> Received By I Titie: <br /> EH Specialist: Phone: L.,CA . 3 11_/C/ <br /> Time in: f I i Time Out: `� .� , JO Pagel of <br /> EHE 16-24 (2n1 pg) 4/3113 FOOD PROGRAM OR WNTINUATJON <br />