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SAN JOAQUIN COUN _ . <br /> :< <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> W <br /> _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sugov.org/ehd <br /> ��FORN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> r cr i,, ,� 1'rrrL • 6-Y-��l <br /> Address: City: Zip Code: <br /> ��h � ,r �, } /'ar 953 <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> 14?e,4 4 i/1 e <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Jo 1/. blc, ,u l t' u n {o u <br /> C G rt Ann I•a � � !12 re � 1r,.4 A A i A1< s�-cs 7FO&6,d r ujns <br /> oppjn G o M <br /> On lop W as S/_5 .4 2030fjon <br /> p Ll h o t u3f o �Ier Q•3 a I. 1'Fy <br /> IA)QS h i el C a 1p, Cod b", /("0 e'l <br /> Li S e or M ere 4 ad <br /> Ndae; I�r G use 4 00% <br /> Item/Location Temperature Item!Location Temperature <br /> CG A Aen 44 1 S'(-Sy rn dc' S S7 f <br /> Sr-S7'11� r <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: J PSS �a Hand Sink: QC 'FChlorine: Ppm Heat: F <br /> Exp.Date: O 3 arewashing Sink: /21 'F Ouat.Amm.: �G ppm Other: 'F <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: l:U G Time Out: Y' S Page of <br /> EHD 16-24 (2n1 pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />