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,oP4 .goo SAN JOAQUIN COUA <br /> za ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> cq., c iP Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.s'-ov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: f Date: 117 <br /> Address: t� �, l� City: 7-eC' L 44 Zip Code: cl 5 ,3 7 <br /> Owner/Operator: 1j Telephone: ty 3 1 yQ 3 <br /> Program Element: Program Record: Inspection Type: <br /> Lvt � ir <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> YY <br /> i <br /> D pro v.- de 0 04/13 o a ahc Cons <br /> hu C6/► �t°r Cun 1fA Z 0 t 4Vj <br /> 10 A A r ho all o <br /> lip In CIO Ihs 346ri, or Pri, I;rf. '540re in <br /> UC � l rrcf 4<, d4 <br /> Item/Location Temperature Item/Location Temperature Item!Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewas ng Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: C <br /> L <br /> EH Specialist: Phone: <br /> Time in: Time Out: Page ?of <br /> EHD 16-24 (2o°pg) 4/9112 FOOD PROGRAM OIR CONTINUATION <br />