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"g"!" SAN JOAQUIN COUNT( <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ = 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sl4ov.orq/ehd <br /> LiFoai; <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: t f7), City: / ., Zip Code: <br /> Owner/Operator: �V ✓✓�� WC Q,kja relo— [�(/ Telephone: <br /> Program Element: 1 ,L Program ecord: D !"� Inspection Type: olty <br /> wch <br /> SB 180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> J V� I K C ✓ tX -6 f7c, v n <br /> S dK4 1q1t <br /> IU t'il✓h0 �WN l-1 <br /> Item/Location Temperature Item/Location Temperature <br /> { - - --- <br /> ,Food SafetyCertification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: aF Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of uat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: ` , Phone: i <br /> Time in: l 1'1 me Out: Page of <br /> EHD 16-24 (2^d pg) 4/3113 if FOOD PROGRAM OIR CONTINUATION <br />