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° ....p.°"�" SAN JOAQUIN COUN' <br /> ...• c <br /> z ENVIRONMENTAL HEALTH DEPARTMENT <br /> Q: <br /> ti <br /> _ - 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:vvww.sjgov.org/ehd <br /> L�FORI� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: �, ` ) 1 __7 Date: — <br /> Address: City. S--. 1"T^U Zip Code: 5 - <br /> Owner/Operator: c� \ (A ��, Telephone: <br /> Program Element: �25 Pro ram Record: `b " Inspection Type: <br /> B180 Posted 9�Yes ❑ Rermit Posted Yes ❑I Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> So'(� <br /> /w <br /> 2 i "1 _1 F e Fr IIG F <br /> ce ` -(-r�5m <br /> - <br /> --S <br /> ,)w INAr 5 2e J • y r� -0- 4-r (tu ✓ `�a <br /> Q <br /> g: <br /> _ Pte,. SZ <br /> `l-t b t� 2 (a-,r4 <br /> 1 - <br /> -Fo 122 Or: ,� -�h��. -fir; :rlZ- `� 1 <br /> (X-\,, c <br /> Food Safety Certification it Facility Hot Water Temperature 11 Warewashing <br /> Name: — (Hand Sink: o chlorine: pp Heat <br /> Exp.Date: Z�^ \ arewashing Sink: \5 of rat.Amm.: %A ppm iOther: of <br /> Received By/Title: <br /> EH Specialist: � �, Phone: <br /> Time in: q , Time Out: `� J�J Page f 3 <br /> EHD 16-24 (2otl pg) 4/3'13 FOOD PROGRAM OR CONTINUATION <br />