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aoP4 ,FA.� L SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.soc]ov.org/ehd <br /> AI Fd i<N <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: �Q <br /> Pi <br /> Address: 0 - L� JIB als city: U,(r L.0 Zip Code: <br /> Owner/Operator: -Fi1G(J `Qty Telephone:Telephone: <br /> Program Element: ( Program Record: Usk,' (-�I Inspection Type: , <br /> i <br /> 8780 PostedKY-es ❑ No Permit Posted IQ Yes ❑No Reinspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 1 PLMIAW a I <br /> d v/ , <br /> AI'10( /6'17'G* • 0'N NN & Ar vim' <br /> C l ki dt ka- <br /> ad v �✓t L v i <br /> 1A4— c� l� <br /> a -- e( Ir wAa t u, <br /> t d/Wq I C6 s . d tiu . C' ,11l h <br /> M ert LPL — 'i <br /> ac a .d iyt api7j w rel <br /> OKA- vt - N11 I01414tak I W 11111IL 1K V-eJ <br /> Item/Location Temperature/ Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification - Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: 'F Chlorine: ppm Ht: 'F <br /> Exp.Date: arewashing Sinkea <br /> : -F uat.Amm.: ppm ther: 'F <br /> Received By/Title: <br /> EH Specialist: _ one: <br /> Time in: �'Lr Time Out: lY r7 /l PagL <br /> of <br /> EHD 1&2d (2^ pg) 1IM `'�� FOOD PROGRAM OIR CONTINUATION <br />