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0 SAN JOAQUIN COUNP <br /> r. 1 ENVIRONMENTAL HEALTH DEPARTMENT <br /> zs 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209)468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> 41FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: -3 S n[ns.-Sem Date: <br /> i7 rl <br /> ddress: — ter - City: Zip Code: <br /> OwnerlOperetor: Telephone: <br /> Program Element: Program Record: -���s3 Inspection Type: <br /> i <br /> 8180 Posted)(Yes ❑ No Permit Posted l(Yes ❑ No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Al D G jzr.A4 -,Ole <br /> Item/Location Temperature Item/Location Temperature Item I Location Temperature <br /> 'Prr` At 'F <br /> Food Safety Certification . Facility Hot Water Temperature - Warewashing <br /> Name: Al Hand Sink: aF Chlorine: ppm Heat: of <br /> Exp.Date: arewashing Sink: / eF Quat.Amm.: ppm Other: eF <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: l� y� Time Out: Page of 17 <br /> EHD16.24(2n0pg) 4/9112 �./' FOOD PROGRAM OIR CONTINUA ON <br />