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SAN JOAQUIN COUNT' <br /> 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 /> L/FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ��) �� _ Date: -7— <br /> Address: 2.L n City: (�� Zip Code: 9 S <br /> Owner/Operator: �G\ Telephone:2 q _ Z <br /> Program Element: Program Record: 1�2%,Ao Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> o, c �1 e. , <br /> 1 <br /> G <br /> V� <br /> L <br /> G <br /> 2 � <br /> c I p 1m P ( 1 <br /> tem/L cation Temperature Item/Location I Temp ature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of uat.Amm.: ppm Other: of <br /> Received By/Title: w(N`•� \� <br /> EH Specialist: 1 1�\ t Phone: q 10 12 <br /> ), <br /> Time in: 11 So Time Out: `Z'-zs Pag of <br /> EHD 16-24 (21 pg) 4/3/13 It F00 ROGRAM OIR CONTINUATION <br /> V�o,(,es SJ Ce I\d - COm F p�X z�j/ <br /> n SP-eC_� x1(7 � �r\v�� � ►��� �or``� � U, si-� . �n�� <br />