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oPq�l" .c SAN JOAQUIN COUNT; r <br /> Z< ENVIRONMENTAL HEALTH DEPARTMENT <br /> .'•. 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> �/PORN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: s `���`_t Date: �2 Z � <br /> Address: City: Zip Code: <br /> Owner/Operator: I'k /17-ga v"TaV � Telephone: zCP <br /> Program Element: Program Record:I 12 lb Inspection Type <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> ���f l/ � � Gl/✓� d( Gt y <br /> 1.tJ V f _ . . <br /> C kit <br /> - /r ' <br /> vv. a <br /> d Fs <br /> kal 4v <br /> r <br /> vzLton6j v- (f o h i— ✓ 1 /e1 <br /> n �_c <br /> C,(,v,Q ✓ VLk- K <br /> D 4- <br /> Item/Location Temperature Item I Location j Temperature Item/Location Temperature <br /> j walk—,P, b <br /> Food Safety Certification Facility Hot Water TemperatureWarewashing <br /> Name: Ha1.nd Sink. "F Chlorine: ppm Heat: °F <br /> Exp.Date: Warewashing Sink: -F Ouat.Amm.: ppm r:Othe °F <br /> Received By/Title: <br /> EH Specialist: �' Phone: Lf <br /> ,n <br /> Time in: i GTime Out: < - Page of, pG <br /> EHD 16-24 (2^'pg) 11/2/09 FOOD PROGRAM OR CONTINUATION <br />