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PQut(y SAN JOAQUIN COUOY <br /> Q` ENVIRONMENTAL HEALTH DEPARTMENT <br /> N: X <br /> - -_ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.si-Qov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: n ) fJl'Lx Date: <br /> Address: City: 6+0 ton Zip Code: 5 0l I <br /> Owner/Operator: 51 114 Telephone: L{11_71 3 I <br /> Program Element: 1 (101_0 Program Record: P rz o1 l B S Inspection Type: - <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Item/Location Temperature Item/Location l Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: AkwewesMg Sink: of Ouat. Amm.: ppm Other: of <br /> Received By/Title: / .J <br /> EH Specialist: ' Phone- <br /> q53 / <br /> Time in: 5 Time Out: 1 ,30 Page2of 2 <br /> EHD 16-24 (god pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />