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SAN JOAQUIN COUVY <br /> x+ ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • m P Telephone: (209) 468-3420 Fax:(209) 464-0138 Web:www.s�o�g/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: �7 /';:-fq )h 4p- Date: [ <br /> Address: City: f �� i Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: ( s Program Record: I;�D 49v i r'`7 Inspection Type;.. y <br /> !" l <br /> B180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIV ACTIONS <br /> C(D C--> <br /> W <br /> c4 F <br /> fl <br /> v 1� <br /> ^ <br /> FAJi ►-� n�� <br /> � � fiI G �l �vK>.U � �- l � <br /> -� I <br /> L 'Y <br /> Itemll_ocation Temperature Temperature <br /> .pod Safety Certification Facility Hot Water Temperature - Wareweshing <br /> Name: Hand Sink: 'F Chlorine: ppm Beat: °F <br /> Exp.Date: arewashing Sink: `F Ouat.Amm.: ppm they: "F <br /> Received By I Title: <br /> EH Specialist: n Phone: -Z,4> 2--3 <br /> Time In: ( Time Out: / Page f <br /> EHD 16-24 (21 pg) 41Y1a FOOD PROGRAM OIR CONTINUATION <br />