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SAN JOAQUIN COU. Y <br /> �+ ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.orq/ehd <br /> �iFORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 0 r 1 Date: _ _ <br /> ddress: 3:102D r City: Zip Code: <br /> Owner/Operator: P Telephone: 3 <br /> Program Element: Program Record: n ig � (0(5 ,9 <br /> fJ as _�C Inspection Type: <br /> SB180 Posted ❑Yes ermit Posted /' Yes P I ( Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> L <br /> h k <br /> -r o v- 1 e VI-P d r <br /> � A LQ <br /> `1 r r 0 L k __V <br /> k- a t ► Y- <br /> r YSl L �-Q r rn O Y�'L24f r0 c, <br /> YLo— Y A-0--p— <br /> - d <br /> c� r c O <br /> I�Lo�,I,L <br /> Y <br /> ro u-+ Lo I11 K-P e pLQ <br /> cc Y <br /> I h r� � •n »7 <br /> Temperature <br /> r — zt5 <br /> <3�O 4- <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: f Chlorine: ppm Heat: of <br /> — <br /> Exp.Date: g Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: bn <br /> Time in: 11010-15Time Out: D' / Page of <br /> EHD 16-24 (2^'pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />