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e <br /> o.Pa"'" SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • cq.. _ ;P• Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.slgov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: I C�, i) Date: <br /> Address: 'I-)U �It� l City: �a-q ax Zip Code:CSS civ <br /> Owner/Operator: j q SI C nt ttvl�v �� ��11 Telephone: GI G _ boo <br /> Program Eleme • /„2 r1 rogra\m�RRecord: 0��cbb-}� Inspection Type: V -h n/) <br /> SB180 Posted Yes 1`(1N�oll Permit Posted Yes, UNo Re-Inspection on or After: I`C <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> cit V i(.Q-- a te4nw cx4— in <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: ,0() of Chlorine: Ppm Heat: �F <br /> Exp.Date: Warewashing Sink: of Ouat.Amm.: ppm Other: of <br /> II <br /> Received By/Title: <br /> EH Specialist: Phone: — <br /> ;WQime in: G . Time Out: i�.�s PagS2 of 2_ <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />