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0'9.W C4 SAN JOAOUIN COUi_ f <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> - 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax:(209)464-0138 Web:www.siAov.orglehd <br /> LfFpR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ? r Date: Z Z2 <br /> Address: f tJ�7 d� City: Zip Code: <br /> Owner/Operator: f �i y Telephone: <br /> Program Element: f Program Record: U bOi 1 Inspection Type <br /> l 3 ", <br /> 58180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> rim ut,- P'�CDIAti le Ir <br /> f <br /> i <br /> JAI <br /> ld <br /> y h0! r v f c ( ✓`l14 ` <br /> yu -k <br /> 1 C~C- rt 6 C <br /> ltem/Lacation Temperature I Item/Location Temperature <br /> Food Safety Certification — k Facility hiot Water Temperature �T Warewashing <br /> Name: Hand Sink: "IF 'Chlorine: ppm Heat: 'F <br /> Exp. Date: arewashing Sink: 9F Quat.Amm.: ppm Other: °F <br /> Received By I Title: <br /> EH Specialist: {f/r - Phone: [—V*] � q <br /> Time in: Time Out: l JV l Pdg of <br /> EHD 1624 (2^ pg) 4W3 FOOD PROGRAM OIR CONTINUATION <br />