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SAN JOAQUIN COON' <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> LlFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: - — C Date: 0 e-' —C�I <br /> Address: Z 7 ?,� W Q ✓,,e L City: G J Zip Code: s Z0 / <br /> Owner/Operator: C 1_ ; © �� L& ) t� Telephone: <br /> Program Element: 6 Z� Program Record: C> S 5 C7 �=' Inspection Type: <br /> SB180 Posted /,&es No Permit Posted - s No Re-Inspection on or After: <br /> OBSERVATIONSAND CORRECTIVE ACTIONS <br /> J4 bcy* a c c�II -e_ - I � f- 0.1 4"_ air . <br /> STb(LZ cM fboCL 1 w r 6 i O Clao r- . <br /> Sol'hj:L- ri , i 5 t, t0�� k�C-0 UQ e_.� ,re(' 0.( i v+•S <br /> 3 TkA- <br /> t,.Jct I Z <br /> Item/Location TemperatureItem/Location-— Temperature <br /> tion .....— - -- <br /> �..xt k e 3� <br /> Joc�f ►". r•� � q <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: C C C , %CQ Hand Sink: 0 'F Chlorine: S� ppm Heat: 'F <br /> Exp.Date: _ _ I n arewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: n_ ) Phone: g _3 yyS <br /> Time in: i I 3 Time Out: /�— Page-20 2_ <br /> EHD 16-24 (20°pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />