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SAN JOAQUIN COUt <br /> a` Za ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.si4ov.orq/ehd <br /> 4�iFORi° <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: � Date: j <br /> Address: City: may,_ Zip Code: <br /> Owner/Operator: Telephone: <br /> C� <br /> Program Element: Program Record: �� Inspection Type: l� <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 74 <br /> Item/Location Temperature Item/Location Temperature <br /> �j -- -- -- <br /> �i`�l� <br /> a. <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: 'F Chlorine: pm Heat: i of <br /> Exp.Date: � 9/av� arewashing Sink:/a, ofQuat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phon �, ��� L <br /> Time in: a O y Time"Out: S Page of <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR COIqfINUATION <br />