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SAN JOAQUIN C'.OUPY <br />� •.OG <br />2r ? 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 />(FOR <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />��-L-� t <br />7 <br />Date: [ 2_ <br />Address: �J <br />V <br />City: <br />%t�wva <br />Zip Code: <br />4 <br />Owner/Operator: <br />Telephone: <br />Program Element: %�i <br />eO <br />ro am Record: root, "l <br />Inspection Type: <br />SB180 Posted Yes <br />Permit Posted s No <br />Re -Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />%t�wva <br />�• ct.�1 <br />4 <br />rvuwrl <br />s <br />U <br />IF <br />Ll <br />VM40VI SIL <br />� r <br />w , <br />2y1f✓� <br />1A%e, 1 <br />(r <br />dfl�C <br />Item/Location <br />Temperature <br />Item / Location <br />Temperature <br />Food Safety Certification <br />Name:!10. <br />Exp. Date: <br />Facility Hot Water Temperature <br />Hand Sink: <br />of <br />Chlorine: <br />Warewashing <br />ppm Heat: of <br />arewashing Sink: of <br />Quat. Amm.: <br />ppm <br />Other: of <br />Received By / Title: V los <br />EH Specialist: <br />Phone: <br />3 <br />Time in: <br />Time Out: <br />Page' of <br />EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />