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.0. .0SAN JOAQUIN COUN <br /> �� SG <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 /> �I PORN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: r`D f` S Date: 3 l <br /> Address: i City: Zip Code: <br /> Owner/Operator: (/ f Telephone: <br /> Program Element: Program Record: D 71 Inspection Type:r <br /> SB180 Posted _ Yes No Permit Poste Yes No �/ Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> ltJ ✓, r� <br /> L � s <br /> , T <br /> srevr 6tv <br /> Item/Location l Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> ---- ---- ---------- -------- .�__._....------ - _ . —.....__..-_................ -- ----- -- — <br /> Name: Hand Sink: I �& F Chlorine: ppm Heat: 'F <br /> Exp.Date: Ware sh niSink: U of Ouat. Amm.: ppm Other: of <br /> Received By/Title: i <br /> EH Specialist: t Phone: -- <br /> ime in: 7 I Time Out: Page;of <br /> "'D 16-24 (2nd pg) 413113 FOOD PROGRAM OR CONTINUATION <br />