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0 <br /> . .eSAN JOAQUIN COUNTY <br /> � � st <br /> y� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �q.. - �P• Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.s�og v.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: f Date: 21 <br /> Address: L City: Zip Code: <br /> Owner/Operator: in/ � �` Telephone: 5-7— <br /> Program <br /> -7_Program Element: V Program Record: Inspection Type: { f 6 <br /> SB180 Posted ❑Yes 11 No Permit Posted ❑Yes [] No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS = <br /> H o av cl�cr( , X01 �n <br /> df weltf <br /> v i � <br /> ru- - l <br /> N Stilu <br /> Item/Location Temperature Item/Location Temperature Item 1 Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: OF Chlorine: ppm Heat: OF <br /> Exp.Date: Warewashing Sink: OF Quat.Amm.: ppm Other: OF <br /> Received By/Title:. Aw ' <br /> EH Specialist: I Phone: 1 <br /> Time in: / Time Out: + ( o J Page of / <br /> EHD 16-24 (2°a P9) 419112 FOOD PROGRAM OIR CONTINUATION <br />