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oPaulN C SAN JOAQUIN COUN' <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.siqov.orq/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility; nevnJ a&% Date: �Z_ c{ y <br /> Address: d Ln <br /> City: �d��" Zip Code: 157—too <br /> Owner/Operator: I G �G Telephone: , <br /> Program Element: 1 10ZS Program Record: S3 Inspection Type: <br /> r <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE.ACTIONS <br /> (0-&S-k/ to 10K S r Z <br /> _ ....._........— <br /> -- .! ✓gid 6 d� s <br /> 1 <br /> Item/Location Temperature Item/Location — Temperature <br /> I <br /> Food Safety Certification Facility Hot Water Temperature Werewashmg <br /> Name: Hand Sink: of Chlorine: ppm Neat: of <br /> Exp.Date: arewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: G <br /> EH Specialist: a \ Phone: y6-%_ w5— <br /> Time in: l^.1 Time Out: Page of <br /> EHD 16-24 (2° pg) 4/3113 FOOD PROGRAM OIR CONTINUATION', <br />