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"'"• SAN JOAQUIN CO&'v <br /> oP ... <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> a4` tiara.. Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.siooy.or0/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: I u Date: Cl/ I� <br /> Address: /a7) S city: Zip Code: <br /> Owner/Operator: - ` 0v Telephone: a2-f--9'%4 <br /> Program Element: I Program Record: GJ Inspection Type: tzowb n <br /> 6180 Posted Ue9 No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> t S i ncA can S i n S . <br /> � itxQ 1 w u <br /> (e dce L uf ea cin <br /> oK tp �sSv-e¢ titer«, 2[5 4J <br /> 1 i v i tills <br /> canh n <br /> LAS -F 2122 <br /> fP/Vi(1U <br /> (-eZpr4 U11 <br /> Item/Location Temperature Item/Location Temperature <br /> .• __ Food Safety Certification Facility Hot Water Temperature _W_ arewashing <br /> Name: Hand Sink: of hlorine: PPM Heat: 'F <br /> Exp.Date: arewashing Sink: 'F uat.Amm.: Ppm ther: 'F <br /> Received By/Title: ((� <br /> EH Specialist: Phone: _ <br /> ime in: /_ Time Out:`''I -C Page of <br /> EHD 1624 (2n°pg) 4W 3 FOOD PROGRAM OIR CONTINUATION <br />