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SAN JOAQUIN COU` Y <br /> N: ?[ <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • •.. P'• Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.orq/ehd <br /> /FOR�� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: �, ` h - j Date: a0 <br /> Address: r rV-���'-4 - 0— I City: Zip Code: <br /> Owner/Operator: J �� , /„A 67 Telephone: <br /> Program Element: Program R or . O Inspection Type: <br /> 8180 Posted es ❑ Rermit Posted Yes ❑1 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> l 7 /�i("�YVfriY� _�- 0 <br /> Item/Location Temperature Item I Location Temperature <br /> Food Safety Certification Faci-lit <br /> y Hot Water Temperature Warewashing <br /> Name: Hand Sink: )� �F Chlorine: ppm Heat: F <br /> Exp.Date: arewashing Sink:/ 'F Puat.Amm.: ppm Other: F <br /> Received By/Title: <br /> EH Specialist: Phone: 61 <br /> ime in: L Time Out: 1 PageZofL <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM 01R CONTINUATION <br />