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SAN JOAQUIN COU .' <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.s*gov.org/ehd <br /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: _ , — Z >I ' � Date: <br /> Address: -1) <br /> Zip Code: QI 2 lj <br /> Owner/Operator: ; \R G Telephone: <br /> Program Element: \ rogram Record: I l Inspection Type: <br /> 6180 Posted ❑Yes ❑ Permit Posted Yes ❑I Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> {S -A o. ` W <br /> � . <br /> •3 �- L—� Cz o. S <br /> . C' 5 Qn c'_ <br /> J <br /> ,1• (N' js tton Temperature,, Item/Location Temperature <br /> L=....................... <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: _) Hand Sink: of iChlorin e: ppm Heat: of <br /> Exp. Date: washing Sink: of Quat.Amm.: ppm they: F <br /> Received By/Title: <br /> EH Specialist: Phone: _k 0�JQ o- 50-50 <br /> Time in: i I +� Time Out: l� Page- f <br /> =HD 16-24 (2n°pg) 4013 FOOD PROGRAM OR CONTINUATION <br />