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SAN JOAQUIN COUO <br /> �.•�� .off <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> .. 4 .. �`�.. Telephone: (209)468-3420 Fax: (209)464-0138 Web:www,sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: A Date: <br /> ddress: /9— (f., L� City: Zip Code: <br /> Owner/Operator: Telephone: `f 73--�- <br /> Program Element: /.2— Program Record: P/? 01(a06;2_ Inspection Type: <br /> SBI80 Posted Yes ❑ Rermit Posted XYes ❑1 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> ° <br /> �r, rcx <br /> r W-p— n <br /> p <br /> 627-S Qt Al d 0 <br /> r v-e_ <br /> Item/Location Temperature Item 1 location Temperature <br /> Cf� <br /> /1 /rl-aim <br /> Food Safety Certification facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: OF hiorine: ppmeat: OF <br /> Exp.Dat Warewashing Sink: D OF uat.Amm.: ppm ther: OF <br /> Re ived B Cha✓ �( <br /> E cialist: Phone: (�J� <br /> Time in: Time Out: OO Pagq„of 2— <br /> EHD 16-24 (2i0 pg) 413113 FOOD PROGRAM OR WNTINUATION <br />