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SAN JOAQUIN COL Y <br /> y� ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �Q.. ;P Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd <br /> <<F0 <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: -.e— Date: /-.3/-/L,/ <br /> Address: 53? r c�-fn qv City: `�_r � Zip Code: '2_0 <br /> Owner/Operator: a a ba 1 r Telephone: Y6 - / <br /> Program Element: /�p ogram R rd: 2 D Inspection Type: 72-o h'/Le <br /> SB180 Posted Yes ! No Permit Posted (Yes n No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> - fl C <br /> _ Item/Location Temperature ftem/Location Temperature <br /> i <br /> I <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp. Date: arewashing Sink: %A 7 of Ouat.Amm.: ppm Other: aF <br /> Received By/Title: <br /> EH Specialist: tl/ Phone: �i� '� <br /> Time in: Time Out: / Pag�of <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />