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aP¢4tn• c SAN JOAQUIN COUNTY <br />b. :5 <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />••�d4l FER��~ • Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.siclov.org/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />Q S <br />v <br />Date: 1 <br />T2-7 <br />Address: , W <br />City: <br />Zip Code: <br />Owner/Operator: <br />Telephone: <br />Program Element: 16' 2 <br />Program Record: /-2 3 <br />C� <br />Inspection Type: L <br />SB180 Posted Yes No <br />Permit Posted Yes No <br />Re -Inspection on or After: <br />f <br />l a 0� <br />OBSERVATIONS AND CORRECT <br />I/rne <br />o/ <br />!• LA - <br />-find <br />el <br />A.04 <br />r - <br />VQ 4 <br />sick <br />G <br />- <br />7)4 <br />"-Tem "'e <br />'Food SafetyCertificat(- <br />Name: <br />Facility Hot. Water Temperature <br />Hand Sink: <br />-_ Warewashing <br />�F Chlorine: ppm Heat: <br />'F <br />Exp. Date: <br />arewashing Sink: <br />�F <br />Ouat. Amm.: ppm <br />Other: <br />'F <br />Received By / Title: TSG <br />� GI <br />✓/ Z <br />Imo' <br />EH —Specialist: � <br />Phone: <br />Al' <br />Time Out: P,. c Z A 1A <br />Page'3 of <br />EHD 1624 (2- pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />