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SAN JOAQUIN COUP <br /> 4 Za ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • c <iFOR�;P• Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sigov.orq/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 0o I eduV ^ ✓ 1k4- Date: <br /> Address: City: Zip Code: <br /> Owner/Operator ��, )n Telephone: <br /> Element: G Program Record: IC wale- <br /> Program Inspection Type:1/ J�,1 <br /> Vf7Vul <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: 4a4L <br /> OBSERVATIONSAND CORRECTIVE ACTIONS <br /> A5 Ashim 64L.6- ov <br /> -- <br /> vw Acftt, - <br /> . ................ ....... <br /> ............ <br /> Item/Location Temperature Item/Location ; Temperature <br /> --- <br /> ------ —= <br /> Food Safety Certification Facility Hat Water Temperature Warewashing <br /> Name: Hand Sink: o f Chlorine: ppm Heat: �F <br /> Exp.Date: Warewashing Sink: of Ouat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: —� Time Out: Pag f <br /> EHD 16-24 (2° pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />