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SAN JOAQUIN COUt <br /> gyp, ...... C <br /> ?� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.slgov.org/ehd <br /> 'q C.IFORt� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: � /� S Date: / <br /> Address: / C City: / Zip Code: �o <br /> Owner/Operator: 1� /� Telephone: <br /> 7 L i 6 <br /> Program Element: Program Record: �O Inspection Type: G/ <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> �i <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: 'F Chlorine: ppm Heat: F <br /> Exp.Date: Warewashing Sink: 'F Quat.Amm.: ppm r.Othe °F <br /> Received By/Ti e: It IV <br /> EH Speci ist: PhonK. <br /> Time in: U. Time Out: - ✓� Page�eff� <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />