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aQu�" TY <br /> SAN .IOAQUIN CC <br /> 'o c <br /> 4' ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> c4�la aaa�p Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sigov•org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: t Date: il <br /> Address: U * L City: t Zip Code: <br /> V � <br /> Owner/Operator: Telephone: <br /> Program Element: /, G Program Record: �-� Inspection Type: <br /> SB180 Posted Yes(•C No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> -- AC Uynat rv�v1. dtJ`cu1 <br /> A,.-_._ <br /> PUA <br /> W h G-1 fAlin <br /> w <br /> -1 2 Gfi oil <br /> o),I <br /> _ yr <br /> vI _ PL-177 G <br /> OrItem/Location " Te erature i Item 1 Location ; Temperature <br /> VWk WW aykukkG w <br /> Food Safety Certification Facility Hat Water Temperature Warewashing <br /> Name: Hand Sink: F Chlorine: ppm I'Heat- -F <br /> Exp.Date: arewaslz rig Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: L'rRIt <br /> ` <br /> EH Specialist: '/ C Phone: <br /> Time in: Time Out: f Page of <br /> EHD 16-24 (2^ pg) 4!3/13 FOOD PROGRAM OIR CONTINUATION <br />