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q"!" SAN JOAQUIN COL Y <br /> Q` ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax:(209) 464-0138 Web:www.s'gov.org/ehd <br /> LI F O'FtN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: yyu tL U d S Date: J—Z : _l <br /> Address: > lzd City: Zip Code: `1`53-7 <br /> Owner/Operator: m A- Cil Telephone: _2� <br /> SlY <br /> Program Element: �U Program ecoed: p(A 05 6) 1 Inspection Type: <br /> SB180 Posted Yes "x No Permit Posted XYes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: 1� of Chlorine: PPM Heat: of <br /> Exp. Date: g Sink: 3 C of Ouat.Amm.: PPM Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: -1 <br /> Time in: V/ 0 <br /> ./ 0 Time Out: Page=of <br /> EHD 16-24 (2n'pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />