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Pau!N SAN JOAOUIN COON' <br /> )0. c <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.sigov.org/ehd <br /> �lFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: — --� b4 I Date: 2_ <br /> Address: 2 SCity: 51 _�CJK-1 _ �("�Yl_ Zip Code: 0A 1 <br /> Owner/Operator: CLTelephone: <br /> ProgramElement: Program Record: Inspection Type:L � <br /> 1 ) <br /> r8—OPosted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 1 <br /> b <br /> �o \. <br /> a` <br /> C <br /> 5e 1 <br /> r r� 2 C \ I <br /> v <br /> 1 ` - l� r✓� L v '� <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: 'F Quat.Amm.: PPM Other: °F <br /> Received By/Title: I' <br /> EH Specialist: Phone: b -� <br /> Time in: Q Time Out: Page f <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />