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SAN JOAQUIN COUN1 <br /> ur X ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.si4ov.org/ehd <br /> �/i=oRa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: T Date: %,3'. <br /> oG <br /> Address: i CA City: i Zip Code: a S uO <br /> Owner/Operator: 1 C v (`� V`J Telephone: <br /> Program Element: 0-Z Progratn Record: 5 —11 \A 9 �c Inspection Type: Cws��1 <br /> VB180 Posted ❑Yes ❑ Rermit Posted ❑Yes ❑1 Re-Inspection on or After: T <br /> OBSERVATIONS AND CORRECTIVE ACTIONS u <br /> t <br /> •f\ v <br /> k— <br /> Item/Location Temperature Item t Location i Temperature <br /> Certification Facility Hot Water Temperature F Warewashing <br /> Name: Hand Sink: ZU of Chlorine: \ ppm Heat: of <br /> Exp.Date: ewar sshing Sink: \-Zo of uat.Amm.: ppmOther: of <br /> Received By/Title: <br /> EH Specialist: Phone: '-A b <br /> Time in: Time Out: �, Page of <br /> Q co <br /> EHD 16-24 (211pg) 413/13 FOOD PROGRAM OIR CONTINUATION <br />