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SAN JOAOUIN COUR <br /> 4 ENVIRONMENTAL HEALTH DEPARTMENT <br /> N: X <br /> - _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �4...• ¢-,�;;P Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.siQov.orq/ehd <br /> <<FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: I i n I6)� S 1 Date: f� �_f V <br /> Address: I y j 0 i U City. L I h r o Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> SB180 Posted Yes No Permit Posted yes No Re-Inspection on or After: <br /> OBSERVATION AND CORRECTIVE ACTIONS <br /> .� <br /> MQIQ S: A) ?M veo�. <br /> 2 _ 5 ;r1 S hey Wol �rr <br /> Item/Location Temperature Item J Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: / Hr Sink: 1,C,c of Chlorine: ppm Heat: —�- F <br /> Exp.Date: I rawest ing Sink: SIS of Quat.Amm.: ppm Other: of <br /> Received By/Titl <br /> EH Specialist. Phone: <br /> Time in: J Time Out: ` Page <br /> of Z <br /> EHD 16-24 (2nd pg) 4/3/13 1 FOOD PROGRAM OIR CONTINUATION <br />