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4WN SAN JOAQUIN COUI` <br />)o � COG <br />z - ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />• c .. - . iP • Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sllaov.orq/ehd <br />4C]F�Re <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: II <br />, fA <br />Date: Z4017,0 <br />Address: <br />N Wk <br />City:L Zip Code: slevG <br />Owner/Operator: <br />', G <br />Telephone: <br />Program Element: <br />Program Record: 0,541pInspection <br />Type:IS <br />B180 Posted Yes <br />Permit Posted CvNo <br />Re -Inspection on or After: <br />EHD 16-24 (2nd pg) 4/3/13 1 1 FOOD PROGRAM OIR CONTINUATION <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />h)nra &A alenvAL P <br />►ZI �► <br />6*roAd- <br />Q <br />To <br />Item/Location <br />Temperature <br />Item / Location <br />Temperature <br />Food Safety Certification <br />Facility Hot Water Temperature <br />Warewashing <br />Name: <br />Hand Sink: ofChlorine: <br />ppm <br />Heat: <br />of <br />Exp. Date: <br />arewashing Sink: of <br />Ouat. Amm.: <br />ppm <br />Other: <br />of <br />Received By/ Title: <br />EH Specialist: d <br />Phone: <br />Time in: <br />Time Out: 1 TUU <br />Page of <br />EHD 16-24 (2nd pg) 4/3/13 1 1 FOOD PROGRAM OIR CONTINUATION <br />