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SAN JOAQUIN COI "Y <br /> 4 .z, 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 /> L!a=o as <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: , z'_:- Lt Date: <br /> Address: G zi City: Zip Code: <br /> Owner/Operator: J Telephone: <br /> Program Element: Program Record: / ` Inspection Type _ <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Ti, A4 <br /> `a-1 i N <br /> Item/Location i Temperature Item/Location Temperature, <br /> Y1 , y�' <br /> Food Safety Certification Facility Hot water Temperature Warewashing <br /> Name: Hand Sink: 'F (Chlorine: ppm Heat: `F <br /> -- I <br /> Exp.Date: Warewashing Sink: 'F Ouat.Amm.: ppm Other: °F <br /> Received By I Title: <br /> EH Specialist: Phone: <br /> Time in: G;� Time Out: Page 7bf <br /> EHD 16-24 (2nd pg) 413/13 FOOD PROGRAM OIR CONTINUATION <br />