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i <br /> PQu�N SAN JOAQUIN COUP <br /> �O. .CGG <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.sigov.org/ehd <br /> gt�F�Ra <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: b 67 Date: <br /> Address: '�LCity: Zip Code: <br /> Owner/Operator: S\ VIN oal VM'P,„jk Telephone: <br /> Program Element: Pfrogram Record: Inspection Type: - <br /> rvb <br /> iSB180 Posted No Permit Posted (!9 <br /> s No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> - <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: 'F Chlorine: PPM Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: PPM Other: of <br /> Received By/Title: <br /> r - <br /> EH Specialist: Phone: <br /> Time in: Time Out: Page of <br /> EHD 16-24 (2n°pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />