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SAN JOAQUIN COUNT' <br /> � •.OG <br /> X ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.s'gov.org/ehd <br /> �JFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: C_�_� Date: <br /> Address: ✓ City: 12�04Zip Code: <br /> Owner/Operator: Q, ,7/1 t� n Telephone: <br /> Program Element: / Program Record: i/ Inspection Type• Y61 � <br /> 6180 Posted lY Yes ❑ Rermit Posted ❑YesY❑I Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> p4k/lK. � t, rig-c.l�- 1 � ` � '1 '/y� a,vvA /tAA 3 )04V-1A <br /> to Vvrd U-e4_. a - <br /> d <br /> IN <br /> Temperature Item/Location Temperature <br /> &� wtL2 51YK <br /> 9 <br /> Food Safety Certification Facility,Hot Water Temperature 111I r+ nip ' <br /> Name: Hand Sink. of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm ther: of <br /> Received By/Title: <br /> EH Specialist: Phone: 9 <br /> Time in: Time Out: Pagf <br /> EHD 16-24(2n0 pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />