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P SAN JOAQUIN COUP <br /> .�o <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.s' ov.orq/ehd <br /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: �� > > �t ,U ru h-� Date: + I <br /> Address: i G,�7 S �1�, 2�0 City: �n Zip Code: 5 L� <br /> Owner/Operator:) '`(6W 1P v U U �fi Telephone: c - Z}} <br /> Program Element: 1�2 l'/1 'Ptrrogram Record: Y�_ N 10t Inspection Type: nS G n <br /> SB180 Posted Yes No Permit Posted Yes No 1 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> v 10 1CACTC cmIC cAeCA <br /> Item/Location Temperature Item 1 Location Temperature <br /> _ -- . ......... - - <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> -- -------- <br /> Name: L0 (_"M - Hand Sink: o f Chlorine: ppm Heat: o f <br /> Exp.Date: 1/2 j ' arewashing Sink: 'F uat.Amm.: ppm Other: o f <br /> Received By/Title: �1 <br /> EH Specialist: (Den,n Phone: "9 _ 344 j <br /> Time in: 1 3 Time Out: Page of <br /> EHD 16-24 (2nd pg) 413/13 FOOD PROGRAM OIR CONTINUATION <br />