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SAN JOAQUIN CCU Y <br /> Z� 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.org/ehd <br /> <<ROR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ryL Y4- �i 1,.1 a I Date: Z <br /> y- 3 -I5 <br /> ddress: .� Y'Y\YYL-Q>f L� city: C Cgtor, Zip Code: <br /> Owner/Operator: S 14 C� Telephone: <br /> 95a-- )CW <br /> Program Element: fico V'-I Program Record: 0 524n q Inspection Type: �I� � <br /> . j-H Q- <br /> 8180 Posted Yes ❑ Rermit Posted es ❑I Re-Inspection on or After: �`- <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> `( Y d4Letl <br /> . V►'S 1� .s dr [a.r� rv� rS <br /> Item/LocationTemperature " Item 1 Location Temperature <br /> r C.'�' �� <br /> a w M44 � y o F <br /> 10 C4 0r � +—U Q fru, _ yo F <br /> tiCE _ - <br /> ood Safety Certification l Facility Hot Water ���r j�� - 1 <br /> Temperature Warewashing <br /> Facility <br /> 1 <br /> Name: Hand Sink: I ZI 'F !Chlorine: ppm Heat:A40 OF <br /> Exp. Date: Wa• washing Sink: `F Quat.Amm.: �U ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: ' <br /> Time in: Time Out: Page2of y. <br /> EHD 16-24 (2n1 pg) 413/13 FOOD PROGRAM OIR CONTINUATION <br />