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SAN JOAQUIN COU* <br /> z` ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.siaov.orCl/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: •Z✓ City: i Zip Code: <br /> Owner/Operator_: Telephone: 2 17Lf <br /> ®, <br /> Program Element: Program Record: A 3 Inspection Type:/1 <br /> SB180 Posted s No Permit Posted yes No Re-Inspection on or After:: G <br /> BSERVATIONS AND CORRECTIVE-ACTIONS <br /> U�c <br /> t <br /> h a c rrr�lvwu�✓^ <br /> olo , <br /> �i <br /> Hem/iocationTemperature �.. 5 Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewash ng <br /> Name: '�� !1 —�--- Hand Sink: /� G) eF Chlorine: PPm� Heat: eF <br /> Exp.Date: i L V arewashing Sink: ��O eF uat.Amm.: PPrn ther: eF <br /> Received By/Title.., 3 ' <br /> EH Specialist: Phone: Lf& S <br /> Time in: r Time Out: r111 U Page20f <br /> EHD 16-24 (2-pg) 4013 FOOD PROGRAM OIR CONTINUATION <br />