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O 'cSAN JOAQUIN COUI <br /> ) OG <br /> Q` ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ( y - Date: <br /> Address: A City: Zip Code: <br /> Owner/Operator: L Telephone: <br /> Program Element: 22 Program Record: Inspection Type: �! <br /> SB180 Posted res - No Per Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> L ' v,Gl�i,,' G 1IV <br /> S l�- - <br /> -- I <br /> !2 <br /> a ka <br /> 70'F 77 <br /> —tan IE Do <br /> Item/Location Temperature'`' Item/Locationt" Temperature <br /> 1 <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: - T- ` Hand Sink: J o f ch-lo-rine:­ - ppm Heat: -F <br /> Exp.Date: Warewashing Sink: `F Ouat.Amm.: ppm Other: of <br /> Received By/Title. <br /> EH Specialist: q� ,1� Phone: <br /> Time in: I �v6 Time Out: �1� Page?of^� <br /> EHD 16-24 (2-pg) 4/3/13( G FOOD PROGRAM OIR CONTINUATION <br />