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SAN JOAQUIN COU Y <br /> 4. ENVIRONMENTAL HEALTH DEPARTMENT <br /> N: :t <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sigov.or /q ehd <br /> LrFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: Zip Code: <br /> V <br /> Owner/Operator: ct41 Telephone: <br /> Program Element: i Program Record: S'�LO Inspection Type:n <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After:, vV W V <br /> OBSERVATIONSAND CORRECTIVE ACTIONS <br /> ---- -- <br /> vvcl�it„r� <br /> Zfi-YYVAA ---- <br /> ebl <br /> "A'- ./v, i*'- - 3 5 <br /> 3 to F --...—...._........---—-- <br /> A a vt, u c `M rF <br /> w <br /> av�i can <br /> — �3 <br /> tem/Location „I;TemperatureMWocatio K Temperature_ <br /> ,, <br /> 3 s N33F <br /> ilffi: <br /> r <br /> _ _ - m� <br /> rater -11Vare <br /> was tiing <br /> Name: Hand Sink: 'F Chlorine: ppm Heat: `F <br /> Exp.Date; Warewashing Sink: 'F Quat.Amm.: ppm Other: 'F <br /> Received By/Title: <br /> EH Specialist: Phone: .0 <br /> ime in: Time Out: // Page of <br /> EHD 16-24 (2nd pg) 413(13 FOOD PROGRAM OIR CONTINUATION <br />