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oP411" c SAN JOAQUIN COUI <br /> X ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sogov.org/ehd <br /> �fFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: . Date: <br /> Address: '6V1 U )V. City: Zip Code: 5 <br /> Owner/Operator: C <br /> J& a Telephone: <br /> Program Element: Program Record: 3,a I Inspection Type: <br /> SB180 Posted No Permit Posted (2�ey No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> - k t <br /> s (�� w, s' <br /> 0 <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: OF <br /> Exp.Date: arewashing Sink: of Ouat.Amm.: ppm Other: of <br /> Received By/Title: \ ^n Q <br /> EH Specialist: Ir V V` Phone: <br /> Time in: Time Out: , Page of <br /> nug, IA <br /> EHD 16-24 (211 pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />