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SAN JOAQUIN COUNT r <br /> 19E x <br /> x ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sagov.org/ehd <br /> �/FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: i. / <br /> Address: I City: x Zip Code: <br /> Owner/Operator: AA A&J t aG Telephone: <br /> Program Element: ( O Program-Record: `_02(yt�f^ Inspection Type: 4 <br /> SB180 Posted es No Permit Posted es No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> o <br /> ----- 1 <br /> jW <br /> FaAA(tft <br /> 0 t_ AVL <br /> AI - % <br /> Item/Location Temperature _ _ Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: ofChlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone•�q(,y f'O 622 <br /> Time In: ; D Time O :v"I ,��Ab ✓J Page of <br /> EHD 16-24(21d pg) 1112109 !/ �✓ FOOD PROGRAM OIR CONTINUATION <br />