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SAN aJOAQUIN COUNT <br /> p .. <br /> .y� 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 /> ��FORt� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: l.� .? Date: Q $�y <br /> Address: r� ) , City: Zip Code: 6? 21_/O <br /> Owner/Operator: OHI^ ` ��� L/ ` Telephone: `7 <br /> Program Element: /�4,1 Program Record: vds b Inspection Type: <br /> SB180 Posted /Yes No Permit Posted >*es No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> r IS d � r , Q S <br /> 11 <br /> i✓� d] t C <br /> iti rid W"tl S S I nl� f' <br /> sal rQ ppjc.,Skea rl fi <br /> Qct ari <br /> Tckfifes wwf( Lc KA-er <br /> N-c epi . e <br /> Item/Location Temperature Item/Location Temperature <br /> e� <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: , - fir ' Hand Sink: �� _. 'F Chlorine: ppm Heat: F <br /> Exp.Date: Warewashing Sink: `F Ouat. Amm. Ppm Other: 'F <br /> Received By/Title: <br /> EH Specialist: �b0>VL yr Phone: <br /> Time in: t( j Time Out: r. Page Zof2__ <br /> EHD 16-24 (20°pg) 4/3/13 , FOOD PROGRAM OR CONTINUATION <br />