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,��gu'—" •ray SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> rg 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sioov.org/ehd <br /> C/FORS <br /> FOOD, PROGRAM OFFICIAL INSPECTION RtPORT <br /> EofFacility:: Io Date:L I,�pLR City: (� Zip Code: <br /> : -l.p��. Telephone:nt: Program ecord: O 2 D Inspection Type: I— Il t <br /> YesNo Permit Posted' as 0 No Re-Inspection on or After: <br /> OBSERVATIONS AND.CORRECTIVE ACTIONS <br /> _. r - <br /> /10 <br />- <br /> QV- <br /> W Cevl <br /> V it ilk <br /> D rte+ � ,o dc,v �lticca-e_'` <br /> J/ <br /> ur h , wU/&— <br /> ,eIA / d4lG+�lZG-n . <br /> Q k�G _ <br /> notit L <br /> Rn 0 �' <br /> UV!g4"- Pkiel0 wy / q(kv <br /> t ✓ - oC <br /> _. _ . - <br /> ItemlLocafion Temperature .lteimY Location • - .Temperature - -7tem'{Location - Temperature <br /> Food$afety'C rtification _ Facility Hot Water Temperature - Warewashing <br /> Name: / Hand Sink: t <F hlorine: Ppm Heat: 'F� <br /> Exp.Date: (� arewashing Sink: 'F Quat.Amm.: ppm Other: "F <br /> Received By <br /> EH Specialist: Phone: <br /> ime in: Time Out: (, 7oPagefZ <br /> /moi <br /> EH 1824(2n0pg)11/2109 I („ V1— � FOOD PROGRAM ORCONTINUATION <br />