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"' SAN JOAQUIN COU Y <br /> Z� ENVIRONMENTAL HEALTH DEPARTMENT <br /> N: X <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �q.. a;P Telephone: (209) 468-3420 Fax:(209) 464-0138 Web:www.s*gov.org/ehd <br /> L/FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: , l Jc kp& Date: <br /> Address: /� City: / zip Code: <br /> Owner/Operator: nr ,11 APt c, - /,�7� ` Telephone: <br /> Program Element: /„ Program Record: 6v� � 3x2 Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 2 c <br /> Item/Location Temperature Item/Location Temperature- <br /> F <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: 'F II <br /> 1 <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> J <br /> Time in: ' '1 Time Out: Lf <br /> Pag17 <br /> of <br /> 2. <br /> EHD 16-24 (2^d pg) 4/3/143 FOOD PROGRAM OIR CONTINUATION <br />