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IIIIIIIIIIIIIIIIIIIN <br /> OPQuIk'•C SAN JOAQUIN CC TY <br /> ?a ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �q.. N;P• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sagov.org/ehd <br /> �/FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: X Date: �U <br /> Address: c � City: Zip Code: <br /> Owner/Operator: J /�a �! r Telephone: <br /> Program Element: Program Record: r1 Gr Inspection Type: <br /> SB180 Posted Yes No Permit Posted y Yes No / Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> je\ CAGL i V�rG lfJ �G l -�L L 141 <br /> TA—A -�,�,�,L- Atf k-, g�- r , <br /> R �. <br /> tet, 1'h� ��c Ll�lk►� u, �vv� i,., . <br /> Item/Location Temperature Item/Location Temperature <br /> 1 �7 <br /> dF <br /> n ALG1�wa 2 y r Af <br /> jl <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: ! 1 J Hand Sink: 'F Chlorine: ppm Heat: F. <br /> Exp. Date: Warewashing Sink: 'F Ouat.Amm.: ppm Other: `F <br /> Received By/Title: 11 r C 1 <br /> EH Specialist: 1 r Phone: <br /> Time in: { f Time Out: Page cif <br /> EHD 16-24 (2n°pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />