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SAN JOAQUIN COUP <br /> 'p ...........0 <br /> •.OG <br /> Z-+ ENVIRONMENTAL HEALTH DEPARTMENT <br /> •'•. 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �4.. �P Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.slgov.org/ehd <br /> R, <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 2 b Date: <br /> Address: 2-:-so City: C ' Zip Code: <br /> J L �- <br /> OwnerlOperator: Telephone: <br /> 141 <br /> — `1 _9 46 <br /> C� '1 <br /> Program Element: 1 Program Record: ` 1 Inspection Type: <br /> n <br /> B180 Posted []Yes ❑ Rermit Posted ❑Yes ❑ 1 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> So C' I v v1 iy..1� �(—�_ CiTC�� Cry �" �'� ' I <br /> \ _ <br /> 2 <br /> \/ -A r <br /> � Yj ^ <br /> Item/Location Temperature Item I Location Temperature <br /> e�r� 3 ►= <br /> _ "X3CLUGVll <br /> Food Safety Certification Facility Hot Water Temperature I Warewashing <br /> Name: _- Hand Sink: i ,�1 of 'Chlorine: _ ppM !Heat: __...--------- F <br /> - - - yy - --- -_ <br /> ---- <br /> Exp.Date: -- �arewashing Sink: of uat.Amm.: pp m Other: of <br /> Received By/Title: / <br /> EH Specialist: - onb�_�� <br /> Time in: z: Time Out: Page of 2 _ I <br /> EHD 16-24(2m pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />