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SAN JOAQUIN COU, <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.s'-gov.org/ehd <br /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: V Date: -1-2-6-1(4 <br /> ddress: I D Q City: Zip Code: - <br /> Owner/Operator: if1� ' Acker Telephone:Lf& <br /> , <br /> Program Element: 1��CDO ogram Record: I s ection Type•- <br /> I 1VD <br /> SB180 Posted ❑Yes ❑ Rermit Posted El Yes E]I Re-Insp ction on or After: 1�10 <br /> OBSERVATIONS AND CORRECTIVE�tCT1ONS `" <br /> 1 U-)-) 1--I Y-e C <br /> c <br /> Y COD L2 <br /> �fn <br /> r -ra, nu- <br /> UL 6-e- <br /> a, <br /> Item lLocation Temper , • Item/Location Temperature,, <br /> a.. <br /> Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of iC lorine: _ wpm Heat: of <br /> ,;ate <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: F <br /> Received By/Title: <br /> EH Specialist: - Phone: <br /> time-in: Time Out. Page of <br /> EHD 16-24 (2^a pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />