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SAN JOAQUIN COUI. r <br /> Z-� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Qc;FaRa <br /> �P Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.si9ov.org/ <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ` t-pi C Date: SLI� <br /> Address: 21 14J 2 City: Zip Code:1.4 <br /> Owner/Operator: ) „I A � Telephone: 313 D/ <br /> Program Element: V`-Program Record: O _0 L+ Inspection Type: J <br /> 8180 Posted ❑Yes ❑ Permit Posted Q Yes ❑1 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> /U Ac cls— cin 3 3 I <br /> V� - ! <br /> IDS <br /> V (� � ti 4 <br /> ►�dliw p� �9' <br /> 2 <br /> - ­ 1 -mow. 7ole <br /> 1 1 <br /> AAk ,AA, e Svc e dF <br /> Food Safety Certification Facility Hot Water Temperature Warewashin <br /> g <br /> Name: Yom: ��� Hand Sink: �F !Chlorine: ppm Heat of <br /> Exp.Date: j 1 arewashing Sink: <br /> ofQuat.Amm.: t <br /> ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: c Time Out: Pag oV, <br /> EHG 16-24 (2n1 pg) 4,3/13 FOOD PROGRAM OR CONTINUATION <br />