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SAN JOAQUIN COUP <br /> 2-� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �q...,c.alp Telephone:(209)468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ¢ Date: Z, <br /> Address: .L�U - City: Zip Code: ry <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: ` Inspection Type: <br /> SB180 Posted a No Permit Posted a No Re-Inspection on or After: W I <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> iw, _�(u - w -lrtou� • -A 11 4d <br /> r'LA <br /> Ite nfLocation 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: Warewashing Sink: of Quat.Amm.: ppm 11 Other: of <br /> Received By/Title: <br /> EH Specialist:. Phone: <br /> Time in: ,-Z-:)I- Time Out: �_ Page of <br /> k-LEHD 16-24 (2''pg) 413113It I FOOD PROGRAM OIR CONTINUATION <br />