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SAN JOAQUIN COUN" 11, <br /> z� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.s*gov.org/ehd <br /> �%FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: �_J ( Date: t �. <br /> Address: d-4 S V V�,�/ City: Zip Code: <br /> Owner/Operator: Telephone: C� <br /> Program Element: Program Record: /'� ' Inspection Type: <br /> B180 Posted ❑Yes ❑ Permit Posted v ❑Yes ❑I Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> r fid` GCS rO <br /> �C <br /> GSC .�M <br /> Item/Location Temperature i, ' -location ! Temperature <br /> Food Safety Certification Facility Hot Water Temperature ( iAt �lr, ft <br /> Name: Hand Sink: °F Chlorine: ppm Heat: of <br /> Exp.Date: arewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: , r Phone: <br /> Time in: �'✓1� Time Out: i O J Page of <br /> EHD 16-24 (21-pg) 4;3!13 FOOD PROGRAM OIR C NTINUATION <br />