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oP°"'"• SAN JOAQUIN COUNTY <br /> ? ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ 600 East Main Street, Stockton, CA 95202-3029 <br /> • 04., U w• Telephone: (209)468-3420 Fax: (209) 464-0138 Web:www.siaov.oro/ehd <br /> �I FORS <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: 31 <br /> Address: " 'VI City: Zip Code: J <br /> Owner/Operator: < aw ' ' one -• , _ [i,•x <br /> Program Element: !_� Program Record: /" I spection Type: O V" <br /> 96 64zMj2-.-1 <br /> B180 Posted es ❑ No Permit Posted es ❑ No Y� Re-Inspection on or After: <br /> OBSERVATIONS ANU`,CORRECTIVE ACTIONS, , <br /> / I <br /> + r <br /> d ' <br /> 1 � � t <br /> MA <br /> 1 r n <br /> 'C'T.X; ItemlLo"catiore : Ternperar <br /> fue Item/Location- + Temperature Item/Loc�tioil "Jemperetura? <br /> a� <br /> ` <br /> ;Food Safety Certification - Facility-Hot Water Temperature - a "' _ WarewAhing, <br /> Name: Hand Sink: /Ob 'F Chlorine: ppm Heat: JFExp.Date: arewashing Sink: )�1T1 =F Quat.Amm.: ppm Other: <br /> Received By I Titl <br /> EH Specialist: hon <br /> Time in: P, / t TimeOut: /r Page of <br /> r d- <br /> EHD 16-24 (21d pg) 11/2109 FOOD PROGRAM OIR CONTINUATION <br />