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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ = 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �q.:• a;P Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sogov.org/ehd <br /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: (� 011 Date: <br /> Address: 22;-,) N m City: Zip Code: <br /> Owner/Operator: G Telephone: _ U O// <br /> Program Element: Program Record: O Inspection Type: L <br /> 8180 Posted ❑Yes ❑ Rermit Posted ❑Yes ❑ I Re-Inspection on or After <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> jkla <br /> vc �� <br /> Item/Location Temperature '� Item 1 Location Temperature <br /> Food Safety Certification �—Facility Hot Water Temperature Warewashing <br /> Name: <br /> Hand Sink: of Chlorine: ppm Heat: F <br /> Exp Date: arewashing Sink: of Quat.Amm.: ppm then: °F <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> ime in: Z Time Out: l�/ �d Page �of <br /> I.HD 16-24 (211pg) 4/3113 FOOD PROGRAM OR CONTINUATION <br />