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Po��N SAN JOAOUIN COUNTY <br /> Z ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax:(209) 464-0138 Web:www.s'gov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ��S Date: Vt O <br /> Address: y <br /> V 1 �y City: (i?� Zip Code: G7 z"0� <br /> Owner/Operator: h f 'N Telephone: (C — <br /> Program Element: 11 (�L Program Record: (JU G 'S9:50 <br /> G5` Inspection Type: C G1UV � l n+ <br /> K8—OPosted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> csl� I Lal n� Z �u r G c�c,*- o 'ICC N <br /> - SIG n+ a we v e. c (c CO q - - <br /> i i"S Gl PIZ • C C :F(V f Ltr W <br /> 0 <br /> C 1 iin 1n b uc + 4eM c. - to s e- <br /> clr nI n M)6 o Pn NC of wo i m s TD� a u+- <br /> �e, C,�-o G <br /> V <br /> M'�\p C I,Ml <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: -F Chlorine: ppm Heat: `F <br /> Exp.Date: arewashing Sink: -F Ouat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: 1 r C' -. l -CO 1 <br /> Time in: /_ - K- <br /> Time Out: v 1 -�Ll 4(0 CO <br /> Page of I <br /> EHD 16-24 (2nd pg) 4013 FOOD PROGRAM ORCONTINUATION <br />