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SAN JOAQUIN COUI ' <br /> ya ENVIRONMENTAL HEALTH DEPARTMENT <br /> 14: X <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �q •.. „ ;P• Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.s4gov.orq/ehd <br /> <<FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: /j/j J' Date: �� 3 <br /> Address: /-51-75 <br /> -59-75 z AF City: Zip Code: <br /> Owner/Operator: Al fi/t (+ J� Telephone: <br /> Program Element: /����V v Program Record: S D a q pec lion Ty AAYXu <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on6r A r: <br /> OBSERVATIONS AND CORRECTIVE.ACTIONS_ <br /> --- --- ---- <br /> 01 <br /> gAj <br /> Item/Loc tion mperature Item l Location, , perature <br /> _ - — ---=— <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: �F <br /> Exp.Date: arewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: - <br /> EH Specialist: Phone: <br /> Time in: , Time Out: Page/of <br /> EHD 16-24 (2n0 pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />