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SAN JOAQUIN COUP <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />cq.,,. .,„Nt'P • Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.s'gov.org/ehd <br />CIFOR <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />1 F -i. , 1 _ 11 43 <br />Date: W - ! N <br />ddress:cls <br />W. q9 lrvr% C E City: <br />I Y `14 <br />Zip Code: CI5 3 16 <br />wner/Operator: <br />3 0 f C r u r` 3: <br />Telephone: ?114- <br />l14, 2 56 7 <br />Program Element: <br />Ib C Program Record: <br />Inspection Type: Pc (; „ <br />rou P <br />8180 Posted Yes <br />No Permit Posted Yes No <br />Re -Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />L <br />I G1. :Y ,. <br />Yf . ,I +j. <br />I:a} ,C} <br />d <br />et"I.i <br />Item/Location <br />Temperature <br />Item / Location —�—Temperature' <br />Food Safety Certification — Facility Hot Water Temperature <br />Warewashing <br />Name: <br />Hand Sink: <br />of Chlorine: <br />PPM Heat: F <br />Exp. Date: <br />Warewashing Sink: <br />of Ouat. Amm.: <br />PPM Other: ,F <br />Received By/ Title: <br />EH Specialist: <br />Phone: # <br />J 16 d <br />! <br />Time in: <br />Go <br />Time Out: 10-.11 <br />Page of <br />EHD 1624 (2n° pg) 4PS13 FOOD PROGRAM OIR CONTINUATION <br />