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3 } T' <br /> ,0¢a sA� SAN JOAQUIN COU <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-62324 <br /> ..._,...�;;� Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www,sjgov_ora/ehd <br /> LfFOR <br /> q �I <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: y—a f Date: �,�. <br /> Address: 7'7 1 ./may City: Zip Code: <br /> Owner/Operator: I •1., -p Telephone: <br /> Program Element: / Progra Record: Z ( Inspection Type: <br /> SB180 Posted Yes ❑ llNoaKn KL <br /> Permit Posted D Yes No Re-Inspection on or After: <br /> OBSERVATIONS.AND"CORREGTUE ACTIONS <br /> � 11" r i; <br /> CVtAl fu <br /> i 1. <br /> IMaW dAjV1' *k44 JV <br /> • - r • �- ' <br /> p I <br /> II } <br /> i 1 <br /> I � <br /> ;i #I <br /> } <br /> ltemlLocation. Temperature r item],Location TemperatuPe. Item I Location" Temperat"ure' <br /> 3 is <br /> Fooii Safety.Certif catiom - :Facil�tar Hot Water Tempe ature .:Warewashlhgt <br /> �. <br /> Name: hand Sink: 'F Chlorine: ppm Heat: F <br /> in 7 <br /> Exp.Date: Warewashing Sink, of uat.Amm.: ppm 110 ther: 'F <br /> i <br /> Received By Titl (1 j r <br /> EH Specialist Phone: <br /> ime in: I Time Out:�fj �� �� Page�ofz <br /> EHD 15-24 (21d pg) 419!12 FOOD PROGRAM OIR CONNT�TIINUATION <br /> � !i <br />