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SAN JOAQUIN COUNT <br />X ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />• cq,, ��P . Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.org/ehd <br />�rFOR <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: 2 V <br />7-Y)i <br />Date: <br />ddress: <br />SCO <br />} City: <br />( Zip Code: <br />rac <br />s3 a y <br />Owner/Operator: t V <br />7 �) j r <br />Telephone: <br />Program Element: i <br />Program Record:S OD b S IJ-6 <br />Type: <br />r�Q 1 <br />SB180 Posted ❑ Yes ❑ No <br />Permit Posted ❑ Yes CI No <br />Re -Inspection on or After: <br />EHD 16-24 (2,d pg) 4/9112 FOOD PROGRAM OR CONTINUATION <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />C rc4cK i <br />(oor 4 <br />(.t1 C) <br />Ci ucK <br />IE/>s 2 I <br />&s have iePn aG;P/ <br />d <br />a +or <br />l- <br />Item/Location Temperature <br />Item / Location <br />Temperature <br />Item / Location <br />Temperature <br />Food Safety Certification <br />Facility Hot Water Temperature <br />Warewashing <br />Name: /'!r <br />Hand Sink: <br />i Q� of <br />Chlorine: <br />ppm <br />Heat: of <br />Exp. Date: <br />A <br />Warewashing Sink: <br />/3 Z 'F <br />l <br />Quat. Amm.: <br />ppm <br />Other: 'F <br />Received By / Title: <br />EH Specialist: <br />Phone: <br />"! v <br />Time in: <br />Time Out: <br />Pagel of <br />EHD 16-24 (2,d pg) 4/9112 FOOD PROGRAM OR CONTINUATION <br />