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o <br /> SAN JOAQUIN COU Y <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �q.. • ,.�;iP Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: A rn Date: <br /> � 2 — <br /> ddress: (0 1 z L1 DQ �_ Al2— City: Zip Code: <br /> Owner/Operator: 1 — Telephone: <br /> Program Element: 1 Z Program Record: n 2 O 1 (0a Inspection Type: � , <br /> osted l Yes ❑ Rermit Posted T' [IYes Re-Inspection on or After: <br /> 8180 P <br /> e ,� OBSERVATIONS AND CORRECTIVE,ACTIONS <br /> /tel.(, W Q Y-e I.ouS <br /> 6for(' YL ric5CO � � li 2 of r . r <br /> � <br /> -e r I o <br /> r <br /> Y '+?Or"-e- r b0 ►-1 ( M<,K-S LA ,S h+ Gav-e Ks - r O V- <br /> w _ <br /> Item/Location Temperature Item/Location i Temperature <br /> I <br /> Food Safety Certification Facility Hafi Water Temperature ` Warewashing <br /> Name: Hand Sink: 'F LhIorine: ppm Heat: �F <br /> Exp.Date: Iwarewashing Sink: 'F .Am <br /> m.: ppm Other: <br /> I 'F <br /> Received By/Title: <br /> EH Specialist: 0n Ji," <br /> � _ Phone: newt --l'? -7 <br /> Time in: r yV v1 Time Out: )2_5 1 Pag of <br /> EHD 16-24 (2ntl pg) 4!3/13 FOOD PROGRAM OIR CONTINUATION <br />