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SAN JOAQUIN COUI <br /> H ENVIRONMENTAL HEALTH DEPARTMENT <br /> = 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: 2 a-'I <br /> Address: /3,A6 live— City: +O Zip Code: Z0 <br /> Owner/Operator: Telephone: <br /> V65-3105) <br /> Program Element: Program Record: �I 0s Inspection Type: n- <br /> SB180 Posted ❑Yes ❑ Rermit Posted ❑Yes ❑1 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> a Y+Z u4.5-fo r> r a r <br /> r e c��1-,L i,+-1, c�.o r �-t •->� v-e� +0 <br /> A- i S Sq wi-�i ?�_ Gi ✓-e G� <br /> bade r v-c, 12-r-P44 rnf-. -�f (, �-Pl to r -aK— v-o o k nk1r)t r <br /> K501-7 OL l.,L 1>p ►moo-- u ro a c, ri-e_ <br /> r t:>o -G U SA d n O Gi- c�.ovr <br /> r W^iik r? -7-2-:5—/ r-e_ <br /> COW-? a4cd <br /> Item Location ( Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm 'Heat: °F <br /> Exp.Date: arewashing Sink: a aF Quat.Amm.: ppm Other: -F <br /> Received By/Title: <br /> EH Specialist: _ L Phone: q63 <br /> _ `22 / n <br /> ime in: ,D T Time Out: / Page,of <br /> EHD 16-24 (2°1 pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />