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SAN JOAQUIN COUK <br /> Z� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> . �q.• :P• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.slgov.orq/ehd <br /> ��FORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ; j.� L, I' Date: <br /> Address: j < (s li% ' t n City: , 1. Zip Code: <br /> Owner/Operator: Telephone: 46 y/y� <br /> Program Element: Program Record: Inspection Type: RQ., ! r <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Item/Location Temperature Item J Location Temperature <br /> . L u Ke ✓✓1�► r -- <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: f Hand Sink: — of Chlorine: ppm [Heat: of <br /> Exp.Date: Warewashing Sink: ofOuat.Amm.: ppmther: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: Time Out: )O C Page of <br /> Page <br /> 16-24 (20°pg) 4/3/13 J FOOD PROGRAM OIR CONTINUATION <br />