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SAN JOAQUIN COUP <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.slQov.org/ehd <br /> �/FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ( A , acx— Date: <br /> Address: q City: Zip Code: %., <br /> Owner/Operator: Telephone: �' X33 L <br /> Program Element: Program Record: z > Inspection Type: k <br /> SB180 Posted Yes n No Permit Posted ^es No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> GZ C fur _ U <br /> Ah2 <br /> Xf <br /> Aff aV I <br /> Item/Loca on Temperature Item 1 Location Temperature <br /> [i(!✓ 40 6T <br /> 10F <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> _ LChlonne: <br /> Name: Hand Sink: 01 .1.- of ppmHeat: 'F <br /> lay 1Exp.Date: Warewashing Sink: of m.: PPM other: of <br /> Received By/Title: ` , <br /> EH Specialist: `a'C Phone: r <br /> Time in: �jb V Time Out: !0 J Page-70' - <br /> EHD 16-24 (20°pg) 4/3/13 ( FOOD PROGRAM OIR CONTINUATION <br />