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SAN .10AQUIN COURY <br /> �� so <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.orq/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Q l 3,S Date: <br /> Address: ) City: rtiL1�y Zip Code: <br /> Owner/Operator: ` J Telephone: <br /> Program Element: !n Program Record: .�Z a Inspection Type: <br /> S131 80 Posted P70s ❑ No Permit Posted >qes ❑No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Item/Location+ Temperature tem/Location Temperature Item/LocatonF Temperature <br /> .- ,_Temp <br /> ry " U <br /> It <br /> Facility Hot Water Temperature "Warewashing <br /> Name: r / Land Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: arewashing Sink: of Quat.Amm.: ppm Other: aF <br /> Received By/Title: / <br /> LI <br /> EH Specialist: Q 1/l/Vi r-� L_ Ph n : <br /> Time in: �` , Time Out: \ I o PagLZof7 <br /> EHD 16-24 (2^"pg) 1/18/12 FOOD PROGRAM OIR CONTINUATION <br />