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�oP..FoG SAN JOAQUIN COUN . . <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />.4...a�P • Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siQov.org/ehd <br />�IFOR <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: 4 0 S <br />07-Rps -e Date: 2,9 , d <br />ddress: 1 <br />W <br />/l'd, S T City: �—Rj y Zip Code: -3 <br />Owner/Operator: <br />u ,?-� <br />Telephone: <br />ti E Gati� UF�.c,�� <br />Program Element: 1G,2 <br />Program Record:jInspection Type: <br />B180 Posted E Yes ❑ No <br />Permit Posted _1 Yes - No Re -Inspection on or After: <br />"OBSERVATIONS AND CORRECTIVE ACTIONS <br />�2�U 1 ov 5 U /aLlA r'u fit! Cao 22E� 7�,p_ - <br />-- - - <br />o U roAtq rtok,5 <br />Item/Location <br />Temperature <br />Item / Location t Temperature <br />Item t Location Temperature. <br />49od Safety Certification <br />Facility Hot Water Temperature <br />Warewashing <br />Name: <br />Hand Sink: "F <br />Chlorine: ppm <br />--- <br />Heat: 'F <br />Exp. Date: S^ 2 <br />arewashing Sink: "F <br />Quat. Amm.: ppmOther: <br />"F <br />Received By / Title: <br />1 <br />EH Specialist; <br />Phone: <br />Time in: ?.-5- <br />Time Out: Page/ of <br />EHD 16-23 (2nd pg) 11106108 FOOD OIR CONTINUATION <br />