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oP411"' SAN JOAOUIN COUI <br /> a: X <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 /> �/EARN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: `Lt Date: �� C <br /> Address: ( <br /> `. i L N City: �) % Zip Code: <br /> Owner/Operator: C' ,�kql ��I^,�, G v Telephone: <br /> Program Element: J Program Record: W <br /> `�j/ �/e Inspection Type: <br /> SB180 Posted Yes ❑ No Permit Posted Yes No It Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Gc i Y 1'GC G . <br /> 4411 <br /> Vl1 �W�y 11W J <br /> Item/Location Temperature Item/Laca i Temperature Item/Location Temperature <br /> 1 ✓ i►'1,( �� Zo <br /> Food Safety Certification•' Fa ityHot Water Temperature warewashing <br /> Name: ' Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: arewashing Sink: ✓ of Quat.Amm.: ppm Other: of <br /> Received By/Tit[ <br /> EH Specialist: Phone: <br /> ime in: G (, ► �'V Time Out: \•• Q✓1 Page 7of <br /> EHD 16-24 (2nd pg) 4/9/12 ` L/ FOOD PROGRAM OIR CONTINUATION <br />