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PQu�N SAN JOAQUIN COI. .'Y <br /> �o ,....-..,.c <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> - _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> 4��Fo.RN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: +ns - � C� # 9-2_9 Date: C) y —17 it ! _ <br /> Address: 7. Q 1 n � City: �+D�"yl�� Zip Code: W <br /> Owner/Operator: 11� T e o�M g y_ 5 I <br /> Program Element: I Lo Program Record: Q a t InspectionType: <br /> SB180 Posted Yes 71o Permit Posted ')(Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> o a.�S,s <br /> 1"d Y I <br /> P r rn ,4 Y <br /> Rem/Location Temperature �� Item 1 Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> -- Ir ---- - - ---- <br /> _ _. <br /> Name: Hand Sink: o f (Chlorine: ppm !Heat: F <br /> Exp.Date: 1 1Warewashing Sink: -F Quat.Amm.: ppm Other: `F <br /> Received By/Title:X/1917 JA`/ ` <br /> EH Specialist: 77Phone: <br /> Time in: 8,00 Time Out: �S Page 2 f z <br /> EHD 16-24 (2n°pg) 4,313 FOOD PROGRAM OIR CONTINUATION <br />