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SAN JOAQUIN COUNTY <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 />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />N <br />Date: O 1 .- <br />Address: <br />City: <br />Zip Code: <br />Owner/Operator: <br />Telephone: <br />Program Element: <br />Program Record: Inspection Type: <br />8180 Posted Yes No <br />Permit Posted Yes No Re -Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />NO <br />SO t-119 C K -rwe N <br />S t 5 LL o cAEv <br />A" <br />W 1 <br />Got1�F3ct-�p aN S <br />ii <br />►Q S p0 t.l't". A <br />R W I <br />b <br />A -r BT 1N5 <br />Cx-riot4 %'6Pogmr W PfOT <br />DIiaY-r0iN <br />'r4 Mo�S'f <br />LN REP it -'r <br />1 <br />GT <br />--< ;, �ttem/Gocation <br />l-bco <br />Food Safety Certification <br />Name:� t <br />Exp. Date: D Z. S Z3 <br />! Temperature Item l Location'. <br />35F <br />Facility Hot Water Temperature <br />'Hand Sink: I OD "F Chlo <br />;rine: 0 <br />arewashing Sink: l �� 'F oust. Amm.: <br />Warewashing <br />ppm II--- <br />ppm Other: <br />Temperature <br />`F <br />`F <br />Received By/ Title: <br />EH Specialist: % I- A l{ 10 1,*- <br />, A41. t4 42,0 Phone: 20 51 <br />I — p .� 2 <br />O �-a <br />Time <br />in: Z ; 410 P Time Out: /.0/0 <br />i <br />Pagevf /1 <br />EHD 16-24 (2-P9) 4/3r 13 FOOD PROGRAM OR CONTINUATION <br />