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"411N SAN JOAQUIN COUI <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> c9�IFaRa�P Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.s'gov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: p� City: Zip Code: <br /> Owner/Operator: WZ� Telephone: <br /> Program Element: �G Program Record: /,� Inspection Type: Yet <br /> 6180 Posted ❑Yes ❑ Rermit Posted ❑Yes ❑ I Re-Inspection on or After: <br /> OBSERVATIONS AND,CORRECTIVE ACTIONS <br /> ✓Vfl <br /> 0 J-IV\ aw ('1 <br /> a WSU ,-Wd-t.d OW U 0-(1vkj- <br /> G�4 <br /> Z44 La v� <br /> H - <br /> Vi <br /> u �v. J v, 3 ---"'yv► A-i <br /> rvrw vV vL V1 WA4Lf WaU <br /> W 'ew CG W <br /> IIn CV\- "n _ <br /> ✓ AV —wrn ,to Wye H 1 F <br /> _- <br /> 144 <br /> ItemlLocatia» Temperature 0 7emDerature <br /> vu ail <br /> t'w D l� <br /> acility Hot Water Temperature Warewashing <br /> -- :. ... <br /> Name: Hand Si <br /> Name: Chlorine: ppm 'Heat: of <br /> Exp.Date: / arewashing Sink: 'F Quat.Amm.: ppm Other: °F <br /> Received By I Title: <br /> EH Specialist: Phone: <br /> ime in: Vo <br /> 47 Time Out: Page�of <br /> EHD 16-24 (2^'pg) 4/3113FOOD PROGRAM OR CONTINUATION <br />