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SAN JOAQUIN COU, i( <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> 4CI FpRi+ <br /> iP Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.si4ov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> ddress: --t•3O r �� City: Zip Code: 2-71-40052 1— 03.2 <br /> Owner/Operator: �'� �� Telephone: (406- <br /> Program Element: Program Record: O -� L Inspection Type: <br /> 8180 Posted VYes E] Permit Posted ❑Yes ❑I Re-Inspection on or After: <br /> {aBSERVATIONS ANO CORRECTIVE ACTIONS <br /> 1 i CAn r 01yItL cAJC - �' C 1 ( I ic. <br /> ye- <br /> QuA- 4- r <br /> y n cL 4- -f-v <br /> �� r <br /> �h <br /> cL. C P -prow u.-t aL-f <br /> c r R n s -F 1 / LI, , <br /> o-E kobs cmA 4-e a r - <br /> a L L, kial-Orclej:±2Agc4T v v- La vj-,- <br /> r <br /> �r ha- 9t r rr,a r>-e 4-•e r rLz '�' a-i C._. -pre 'cam <br /> r e Pr <br /> r r Le_ G-h ai n <br /> G .• iXs cx r - v\-,qtr <br /> Ij to r o U, <br /> 0-5A ni rC_e) 'I ' <br /> rex c i U hj;? -t '04%p ui 4c r - p c -kc <br /> W L+)-) 4-cu �_1-2�1 _ �vn G-+; e»a <br /> 'ItemlLocation Temperature ' Item f Location �� Temperature <br /> Food Safety Certification";, Facility Hot Water Temperature Warewashing <br /> _ - <br /> Name: and Sink: nF Chlorine ppm Heat: of <br /> Exp.Date: arewashing Sink of Quat.Amm.: ppm Other. of <br /> Received By/Title: y� j <br /> aL <br /> EH Specialist: l Phone: <br /> T - - - <br /> Time in: Time Out: O; 0 -21 <br /> Page of <br /> EHD 16-24 (2ntl pg) 4,313 FOOD PROGRAM OIR CONTINUATION <br />