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SAN JOAQUIN COUV <br /> 'Z ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> c oli aa�':P Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility; 4 41-f <br /> Date: <br /> Address: City: l Zip Code: <br /> C'L <br /> Q <br /> Owner/Operator: 4 JL tj <br /> efephone: ,�tj: <br /> Program Element: 'C�• Program Record: G Inspection Type: v <br /> 58180 Posted Yes [INo Permit Posted G Yes ❑ No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> a <br /> aL <br /> s <br /> U 'JJ f <br /> S tics <br /> AWILV D 1 J „ <br /> item/Location Temperature Item I Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Tempera_ture Warewashing <br /> Name: Hand Sink: ofChlorine: PPM Heat: 'F <br /> Exp.Date: W r washing Sink: 'F Quat.Amm.: PPM Other: eF <br /> Received By/Title: <br /> EH Specialist: Phone: 6 <br /> `0'> <br /> J <br /> Time -34 <br /> in: f�, Time Out: /0-140 <br /> `r- 4 <br /> / Page of <br /> 6 ( 1 <br /> EHD 16-24 (2,dpg) 419!12 FOOD PROGRAM OR CONTINUATION <br />