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SAN JOAQUIN CO R <br /> y+ ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • .. ;P• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.slgov.org/ehd <br /> 9 C i F o'�ei <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: , <br /> Address: `, City: Zip Code: <br /> Owner/Operator: *-V Jo Telephone: q f <br /> Program Element: 16� D Program Record: pp <br /> on eon T ply �1 6� <br /> SB180 Posted - Yes No Permit Posted 7 Yes Fl NNo Re-Ins ection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 6M AGI' 01 <br /> a� s <br /> G <br /> vl <br /> C6� <br /> .e A .k <br /> _ � & Prn <br /> t 1 s <br /> 611 I!e,A <br /> 121 L- y <br /> J' K tV !f lkv- v / gymPA(/(. � 2 <br /> r ( hin 0 lw"( 10 <br /> Item/Location Temperature Item/Location Temperature <br /> ---- <br /> I 71L. <br /> Food SafetyCertification Facility Hot Water Temperature Warewashing <br /> — ......_.._ - <br /> Name: Hand Sink: of Chlorine: ppm Heat of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: ' / c <br /> EH Specialist: ll I-C.' Phone: <br /> Time in: O'C/ Time Out: Page)of <br /> EHD 16-24 (21a pg) 413/13 FOOD PROGRAM OIR CONTINUATION <br />