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J�Qu!" SAN JOAQUIN COUP <br /> 4 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 v <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sigov.om/ehd <br /> L�FOR�' <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: \ _\ - Date: ;_2'6- 15- <br /> Address: <br /> SAddress: , y City: 1, Zip Code: S <br /> Owner/Operator: �F- Telephone:aS i - Iq <br /> Program Element: moi Program Record: 2 Inspection Type: <br /> SB180 Posted Yes No Permit Posted es No Re-Inspection on or After: <br /> C3BSERVATiIflNS;AN - `„+ORRECTIVE;,ACTItONS <br /> .............�� ..... <br /> �`CiZ <br /> SCS <br /> Vis.. __•t._S__.__ _ � � �_ �� 1 <br /> C'\ <br /> u \ \ .�.� <br /> • C <br /> Se- z ' <br /> -- .... ....._.............__..........-- <br /> Item/Location ' Temperature Item 1 Location i Temperature <br /> .. --- <br /> �) <br /> 'Z GO\ --r <br /> \ _ <br /> ------ <br /> `A2 F <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: Cr F Chlorine: ppm (Heat �F <br /> _ _.._ <br /> Exp.Date: rewashing Sink: ;� of Quat.Amm.: ppm Other: of <br /> Received By/Title: 1 � � --- <br /> EH Specialist: Phone: <br /> Time In: Time Out: , . Page-,of Z <br /> EHD 16.24 (211 pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />