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"I" SAN JOAQUIN COUNP <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.s'gov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: J <br /> Address: �� City: Zip Code: <br /> -•^ <2 C2r <br /> cle <br /> Owner/Operator: Telephone: <br /> Program Element:^, Program Record: US 0 Inspection Type: <br /> S6180 Posted YesNo Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> P� <br /> A10 v <br /> La,"It d le— &,Ws.AC�l <br /> l SSu e ?�I© <br /> Item/Location Temperature ,ILeILLot " emperature <br /> Food Safety Certification Facility Hot Water Temperature War, ashi <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: OF Quat.Amm.: ppm ther: OF <br /> Received By/Title: 0/2 z cr TF77 2(9 :7 3 v L, <br /> �is�.fon' Phone: !' <br /> EH Specialist: �i>t.��+-77 <br /> Time in: - , S Time Out: 2:1:W Page of <br /> EHD 16-24 (20°pg) 413/13 FOOD PROGRAM OIR CONTINUATION <br />