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oP41'" SAN JOAQUIN COUP <br /> ).•. .COG <br /> W , X <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �q...,o �;p• Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.si4ov.orq/ehd <br /> <<Foa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: O . Date: <br /> Address: 'W5-0 <br /> w1 City: Zip Code: 4c—�5•� <br /> Owner/Operator: C�A.-tj Telephone: I <br /> Program Element: Program Record: 17� �-36 10q Inspection Type:`� Q.J( <br /> B180 Posted Yes Permit Posted fes No Re-Inspection on or After:/ <br /> OBSERVATIONS AND CORRECTIVE ACTIONS ML <br /> a.. <br /> V a • <br /> 0 zoi 1 <br /> Item/Location Temperature Item PLocation Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: F <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: aF <br /> Received By/Title: / �! l f <br /> EH Specialist: 7 Phone: <br /> Time in: q• Time Out: : 3 Page of <br /> awe, <br /> EHD 16-24 (2^a pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />