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SAN .JOAQUIN COI. 'Y <br /> 14: : X <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.orci/ehd <br /> L�FOft <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: u; ► z r ` Date: r 5 <br /> Address: City: f Zip Code: <br /> Owner/Operator: ftv ` Telephone: <br /> Program Element: Program Record: f/J Inspection Type: /L^l <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATEQNS�1NQ CqRRECT[V ATiC3NS <br /> .................. <br /> .......... <br /> ..................- ............- .................... <br /> ........................... ..................... <br /> ............... I.............................. <br /> ........... <br /> ........................... <br /> Item/Location a:Temperature " Item 1 Location I Temperature <br /> _ ___� _ __._ _.� �_. ..._....: <br /> -- - -� <br /> AA <br /> Food Safety Certification Facility Hot water Temperature "° Warewashing <br /> — _ ... _...._ — --- - <br /> Name: Hand Sink: F Chlorine: ppm at: `F <br /> Exp.Date: Warewashing Sink: 'F Quat.Amm.: ppm Other: 'F <br /> Received By/Title: r <br /> EH Specialist: Phone: <br /> Time in: Time Out: ^ Pag of, <br /> EHD 16-24 (21�pg) 4013 FOOD PROGRAM OIR CONTINUATION <br />