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PQu�" SAN JOAQUIN COUR <br /> Za ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> gCjFpRia <br /> �P Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.s4gov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 6 jam, Date: <br /> Address: V w <br /> }- City: S dLK-r ) Zip Code: <br /> Owner/Operator: 1 Telephone: <br /> Program Element: Program Record: I vK � Inspection Type: CA-1 n+- <br /> SB180 Posted ❑Yes ❑ Permit Posted ❑Yes ❑f Re-Inspection on or After: <br /> cog S I S 11 n 1 <br /> v <br /> c,n vw�r ivv.e <br /> SClr\ u� <br /> -� t S a e <br /> Item/LocationTemperature item/Location Temperature <br /> oFaciod Safety Certit Hot Water Temperature , Warewashing <br /> Name: Hand Sink: of iChlorine: ppm ',Heat: °F <br /> Exp. Date: arewashing Sink: 'F �Quat.Amm.: ppm iOther: oF <br /> Received By/Title: <� 0 <br /> o J <br /> EH Specialist: Phone: (I_ <br /> Torr m <br /> ime in: i Time Out: 11 d J I Page I of <br /> EHD 16-24 (2ntl pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />