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SAN JOAQUIN COUI ' <br /> ' ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.si4ov.org/ehd <br /> �IFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: t' -) 6 Date: c <br /> Address: 1� L et p� City: Zip Code: <br /> Owner/Operator: 1 Y w Telephone: <br /> Program Element: j y� Program Record: 7 Inspection Type: <br /> VB180 Posted ❑Yes ❑ Rermit Posted ❑Yes ❑ I Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> AlAk n-&jmal&JVWV_r-!�j ' <br /> riA Nkl <br /> ti U t <br /> v 4 <br /> AM- ga JA <br /> vv <br /> OIL <br /> : <br /> Loca �Temperature � em I Location ; Temperature <br /> c1lity Hot Water Temperature Warewashing <br /> Name: ' Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: c of Quat.Amm.: ppm ther: of <br /> Received By/Title: <br /> EH Specialist: Phone: _q y <br /> Time in: Time Out: !So / Page°►of <br /> EHD 16-24 (211 pg) 4!3'13 V FOOD PROGRAM ORCONTINUATION <br />