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��P4f'o4 SAN .JOAQUIN COUP <br /> q: < <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> 4lyb"a�' <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: L Date: W2(� C <br /> ` <br /> Address: " N 10 <br /> ` City: Zip Code: <br /> Owner/Operator: Md .t 1 . arl s Telephone: tP _ -7Z_ <br /> Program Element: W C)2L Program Record: '(;F OQ-. 2 F Inspection Type: I <br /> 6180 Posted O Yes ❑ Remit Posted O Yes ❑1 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> L L ) <br /> T Y1�1 L( ry�. <br /> }t/ Lr,fKt Pevwwf' U ac <br /> ty g u u*- : u r n i- as ism -1s <br /> �-Foc1d U lP�r G c� S <br /> Item/Location Temperature Item I Location Temperature <br /> GLl1 Y03 Fr- <br /> vet, vie, <br /> ✓rth • I ' <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: 1 and Sink: 'F hlorine: PPM r <br /> eat: "F <br /> xp.Date: 1 arewashing Si k: ` "F ruat.Amm.: ppm ther: ^F <br /> Received By I Title: tl- <br /> EH Specialist: Phone: <br /> Time in: _ Time Out: = 7 /1 Page of <br /> EHD 1624(2°pg) 4013 7 V - FOOD PROGRAM OIR CONTINUATION <br />