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oPa"`"• SAN JOAQUIN COUNT <br /> y� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> d4tredsap Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.siclov.org/ehd <br /> r <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: •� /OZP - City: S�W'rw <br /> Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record:D . ' 42 Inspection Type: fi <br /> 8180 Posted .1 Yes No Permit Posted D Yes c Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> I r I_r �? f <br /> O( kVKr 411WI / / / �vl (/ lZrrif77li <br /> H � <br /> � c fl/yYt/ C�DJ'J — rYti <br /> 4N ✓Pk - <br /> <I 717 <br /> 01 (/1 a -� <br /> 4—U IJA <br /> I v "- t <br /> '��vLr <br /> I of -- I <br /> I <br /> ''AA 1 em/Location Temperature Item/Location Temperature <br /> �V• r <br /> r1r�c�—fr 3 filly <br /> >' y /ur�cGr vl� <br /> u A114)) Z <br /> Food Safety Certification Facility Hot Water Temperature Warewashing -( <br /> Name: '/1,^„ and Sink: 'F Chlorine: PPM Heat: 'F <br /> Exp.Date: `N arewashing Sink: .F oust.Amm.: PPm Other: .F <br /> Received By/Title: <br /> EH Specialist: / Phone: <br /> Time in: Time Out: Page�if <br /> END 16,24 (V Pg) 4013 FOOD PROGRAM OIR CONTINUATION <br />