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SAN JOAQUIN COU. <br /> N: X <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd <br /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> CA l U , x; �,r <br /> ddress: — *ty O Q City: MG U^ Zip Code: 3 <br /> Owner/Operator: Telephone: Z <br /> Program Element: , Program Record: `� Inspection Type: <br /> B180 Posted V,�/Yes ❑ Permit Posted ❑Yes p Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> o U 0 /\r"rA _ <br /> S� k kn <br /> 2 <br /> � I <br /> 1 <br /> 2- <br /> - <br /> 12 - <br /> t <br /> Itemlt.ocation '` Temperature Item I--L. cation Temperature <br /> L - 2-cV.L 14sks <br /> \3-7 - <br /> �Fodd Safety Certification r Facility Hot Water Temperature77 <br /> Warewashmg <br /> 1 . 1. _ . - <br /> Name: Hand Sink: of ppm Chlo \1 Heat: of <br /> Exp.Date: arewashing Sink: _ of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: li _ <br /> Time in: \21 <br /> Time Out: ; Page of <br /> L-HD 16-24 (2ntl pg) 4/3!13 FOOD PROGRAM ORCONTINUATION <br />