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SAN JOAQUIN COUNTY <br /> Z, ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.s'gov.org/ehd <br /> �i FORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: v Date: IZ b <br /> Address: V- L a(Al City: S�U14 Zip Code: CI <br /> Owner/Operator: - � Telephone: <br /> U cwt u <br /> Program Element: Program Re rd: Uy 5`I tit Inspection Type: <br /> SB180 Posted Yes Permit Posted es) No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> '1- <br /> vw <br /> Item/Location Temperature Item t Location Temperature <br /> - -------- — -.... <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: 'F Chlorine: ppm Heat: 'F <br /> Exp. Date: arewashing Sink: �F Quat. Amm': ppm Other: 'F <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: Time Out <br /> \o • : tVti �1 V Page of <br /> '-.4 �nw. l 1 <br /> EHD 16-24 (2nd pg) 4/3113 FOOD PROGRAM OR CONTINUATION <br />