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SAN JOAQUIN COUN <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • ��•.., a,.�;;P. Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.se ov.org/ehd <br /> CIFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: — Date: <br /> Address: 1 s d U F4 G f l u ,� City: �C% a h ro Zip Code: 9 S 3 O <br /> Owner/Operator: ' W n Telephone: <br /> Program Element: f I Program Record: S �� ` �V 3 Inspection Type: r• ^`� <br /> 1§131180 Posted Yes t'No Permit Posted Yes No Re-Inspection on or After: <br /> I <br /> OBSERVA,TIflNS'AND CORRECTIVE ACTIONS` <br /> fcilYjC 5UG ----Gad 0ualr .10Wtl5 d: Spensers prior 4o ��-��._--- i <br /> t6-; r I; Ono C c J2 C; r Ofecr .__ Coreecl h <br /> pry V. 0 ".1ela0eI r-F A br,✓ hr- , nreQ . <br /> tr►rJ <br /> rov; (4, rop CkreCAce re l d i Y\ <br /> i <br /> k rc� <br /> ItemlLocation _ Temperature item I Location . ' Temperature <br /> _._._....... <br /> ___---_- <br /> Food Safety Certification Facility Ho#Wafer Temperature Warewashing <br /> Name: Hand Sink: °F Chlorine: ppm Heat: `F <br /> Exp.Date: �' arewashing Sink: 'F Quat.Amm.: ppm Other: 'F <br /> Received By/Title: <br /> EH Specialist: Phone: Ali i <br /> Time in: 1. ) C� Time Out: Page of <br /> EHD 16-24(2^d pg) 4/3113 1 FOOD PROGRAM OIR CONTINUATION <br />