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of <br /> op41'" SAN JOAQUIN COUNTY <br /> �.• ..0 <br /> N: X <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> • .. ;P• Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sjgov.org/ehd <br /> �iFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: V� Date: I I <br /> Address: ZsZ S City: okk Zip Code: <br /> Owner/Operator: al Telephone: <br /> Program Element: �Ir D Program Record: 'N' I� y1C/ 1 pe on e: <br /> SB180 Posted G Yes ❑ No Permit Posted F-Yes ❑ No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Gll/( ct M` — <br /> W� <br /> � c Crr v <br /> Y <br /> Item/Location Temperature Item/Location Temperature Item/Location _temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of 'urine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: U <br /> EH Specialist: Phone: toe <br /> ._ <br /> Time in: 01 Zv Time Out: ® � 0 Page of <br /> EHD 16-24(20°pg) 11/2/09 FOOD PROGRAM OIR CONTINUATION <br />