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°'4"1" SAN JOAQUIN COUP` <br /> �O. .COG <br /> H X ENVIRONMENTAL HEALTH DBL-ARTMENT <br /> 1868 East Hazelton Avenue, Stockton, �A 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.si4ov.orq/ehd <br /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: 77 r7/7 <br /> Address: V"` City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: `n Program Record: , Inspection Ty Ln �� <br /> 8180 Posted lY Yes ❑ Rermit Posted t❑Yes Elt Re-inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Z jklk a-vl-C Ik C .l _,-Ted . i <br /> ark V <br /> „Pry A Ae4 - x'a <br /> W\44.4 5 15 <br /> Oft A <br /> Item/Location Item 1 Location <br /> _ �. <br /> ✓vGt yt <br /> .� . . <br /> N � <br /> - ��EI'�afe#y� ��t�ica'hon � � ��-�-�- Facility Hot Water Temperature Warewashing <br /> Hand Sink: of (Chlorine: ppm (Heat: F <br /> Exp.Date: arewashin k: 'F Quat. Amm.: ppm they: 'F <br /> Received By/Title <br /> EH Specialist: Phone: LNU I <br /> Time in: p ! Time Out: Page of <br /> EHD 16-24 (2n1 pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />