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P4WN SAN JOAQUIN COUN i Y <br />ya ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />• cqa;P • Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.s*gov.org/ehd <br />�iPOR <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />%'% �� . ✓ r � r- � <br />ate: <br />Address: <br />q S• <br />/ <br />r l� <br />City:` ` Zip Code:' <br />/ i ci <br />Owner/Operator: Yqt4 <br />Telephone: <br />/� �.� _'5D �•l <br />Program Element: j / <br />Program! Redo d: <br />Inspection Type: <br />r <br />SB180 Posted es ❑ No <br />Permit Posted lKyes ❑ No <br />Re -Inspection on or After: <br />EHD 16-24 (2,d pg) 419112 FOOD PROGRAM OIR CONTINUATION <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />1 CUU rs <br />0/,jC1-e a' <br />n ro :J r? <br />GI Y -f? C9 r7 lw�f `tii 7L-7 r <br />Vis. <br />�- v <br />�c1 <br />Z q;- <br />r- <br />r <br />Item/Location <br />Temperature <br />Item ! Location <br />Temperature <br />Item ! Location <br />Temperature <br />Food Safety <br />Certification <br />Facility Hot Water Temperature <br />Warewashing <br />Name: t,1 <br />1 G <br />Hand Sink: <br />of <br />Chlorine: <br />ppm <br />Heat: of <br />Exp. Date: /�,_ <br />_ <br />arewashing Sink: <br />of <br />Quat. Amm.: <br />ppm <br />Other: of <br />Received By / Title: <br />EH Specialist: <br />lPhone: <br />1�� <br />> <br />Time in: <br />Time Out: J - Page of <br />EHD 16-24 (2,d pg) 419112 FOOD PROGRAM OIR CONTINUATION <br />