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o.Pou�N.,c <br /> SAN JOAQUIN COUS <br /> y. X ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ = 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> c'9�;FO0"" Telephone:(209) 468-3420 Fax: (209)464-0138 Web:www.si-gov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: �� �� <br /> ddress- � — `/ j U .j Date: _ <br /> �2 QW S— 3� S <br /> Owner/Operator: 1 1 ' M <br /> M �e + zip'Code S3� <br /> N n^ c ( Telephone: i;P -O <br /> Program Element: Program Record: <br /> S Inspection Type: <br /> 8180 Posted Yes ❑ Rermit Posted "CZes ❑IRe-IU ,''e <br /> nspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS= <br /> SS <br /> I <br /> OL `A- - � S <br /> ItemiLocation Temperature Item I Location Temperature <br /> Food SafetyCertification <br /> Facility Hot Water Temperature Warewashing <br /> k _ __ �__ . <br /> Mme: Hand Sink: of Chlorine: ppm Heat: of <br /> P. Date: crew shing Sink: of Quat.Amm.: ppm Other: of <br /> 'ceived By/Title: <br /> '1 Specialist. - \„ Phone: b <br /> V \ Time out.. Page f <br /> w F0ou PROGRAM.O\R CONTINUAS\ON <br /> a� <br />