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SAN JOAQUIN COUY <br /> Q` ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> c4., iP Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.slgov.org/ehd <br /> ��FORN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: L r (J Date: <br /> Address: f City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: /,,�c�' Program Record: 0-S' 37 � Inspection Type: ` <br /> SB180 Poste Yes No .) Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Cz/ _Y <br /> Item/Loc'; n 'temperature Item J Location Temperature <br /> jVjrV <br /> InIaA <br /> ' Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: //,,,, ��{{''JJ Hand Sink: %' o Chlorine: Heat: <br /> ��1Rv ��1 p l I �L) F Ppm OF <br /> Exp.Date: arewashing Sink: n of Quat.Amm.: ppm Other: of <br /> Received By/Title: G <br /> EH Specialist: S r Phone: <br /> Time in: ,D Time Out: Page�f <br /> EHD 16-24 (2n1 pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />