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SAN JOAQUIN COU. Y <br /> � •.OG <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.orq/ehd <br /> �/FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Q Date: ;2-- o?-O <br /> Address: p1 r .Lr m,O L City: G� fin Zip Code: 1 �j.3 <br /> Iffi <br /> Owner/Operator: la r,�T Lo W�T J Telephone: 4 -7 .7 72 <br /> Program Element: 'y PrograrTI Record: 521 <br /> a�.7 Inspection Type: <br /> B180 Posted ❑Yes ❑ Permit Posted ❑Yes ❑ I Re-Inspection on or After: K-G <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Ctf YJ6 <br /> O • LC / O r Ver . <br /> CIC-1'42 rrt.o n YQ C, r C cz /"L42 144t r <br /> V 10 62--Her" <br /> - r,� �o ✓�-��ol <br /> Item/Location Temperature Item/Location Temperature <br /> a <br /> _ — <br /> .«. ; I,tiBl ,ienature ., uyarewasfiingUNION <br /> _._....._ _ <br /> Name: Hand Sink: o ri Heat: <br /> F 9l/c/ppm oF_ <br /> Exp. Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: ) - Phone: �5. <br /> Time in: 3 a l/W, Time Out: j6) • O Page/of <br /> EHD 16-24 (21 pg) 4'3113 FOOD PROGRAM OIR CONTINUATION <br />