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oW 4111-c, --wea SAN JOAQUIN COUN"
<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.orci/ehd
<br />FOOD PROGRAM OFFICIAL INSPECTION REPORT
<br />Name of Facility: Ei _i p 1)C) Date: jji Date: 1//c//clic
<br />Address: 9 50 t/tA (J 14 WAA1 City: Zip Code:
<br />Owner/Operator:A1 Oa f I 171144 Telephone:
<br />Program Element: i I (f
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<br />Itrogram Redord: 0 Coq 11 c Inspection Type: 4.2 i ii
<br />SB180 Posted.44Yes No Permit Posted 4Yes No Re-Inspection on or After:
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<br />OBSERVATIONS AND CORRECTIV ACTIONS
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<br />Item/Location Temperature Item / Location Temperature
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<br />Food Safety Certification Facility Hot Water Temperature Warewashing
<br />Hand Sink:
<br />I ' ) °F Chlorine: ppm Heat: `F Name:7 -& ), i, vj /4( i , t,
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<br />„44.4,
<br />Exp. Date:
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<br />Warewashing Sink:
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<br />. Guat. Amm.: ppm Other: °F
<br />Received By / Title: /
<br />(-17,/,e1, -64f
<br />EH Specialist: Phone: Of //
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<br />-I 4-- Time in: 6 Time Out: Page 1f
<br />END EHD 16-24 (2^, pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION
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