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o.P4"'" SAN JOAOUIN COUR <br /> � �.coG <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • = :P• Telephone:(209)468-3420 Fax:(209) 464-0138 Web:www.sugov.org/ehd <br /> 4:j ij <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ywy ,V I v Date: <br /> Address: L _ City: Zip Code: <br /> `` <br /> Owner/Opera or:' I _ v, Telephone: <br /> Program Element: Program Record: O ( Inspection Type: <br /> SB180 Posted ye No Permit Posted yes >- No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> N O - <br /> at <br /> Item/Location> Temperature Item/Location T mperature <br /> Li-- --- -- 3 I � l`- - <br /> Food Safety Certification Facility Hot Watery Temperature Warewashing <br /> _...._ -- ---- .......... <br /> Name: C Ll Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warew s in Sink: of Ouat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: f Phone: <br /> ime in: w I�,a� Time Out: Page of <br /> EHD 16-24 (2nd pg) 4/,3/1'9/ FOOD PROGRAM OIR CONTINUATION <br />