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0 °"`" cSAN JOAQUIN COUN <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> cq., iP Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.s*gov.org/ehd <br /> ��FORtN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: f h r2 `� < Date: /� <br /> Address: 01 t City: Zip Code: <br /> Owner/Operator: Telephone: <br /> 4 74V <br /> Program Element: Program Record: V14 7 Inspection Type: Lem, <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> A1116", -nJ <br /> l �rtv <br /> n'1iG r� <br /> It � - <br /> Item/Location i Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: )C` v V/ 6l Hand Sink: o f Chlorine: ppm Heat: F <br /> Exp.Date.: n arewashin Sink: of Ouat.Amm.: ppm Other: of <br /> Received By/Title J <br /> EH Specialist: Phone: — <br /> Time in: /9 -1-37 <br /> /) /2 Time Out: t Page of <br /> EHD 16.24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />