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°W" SAN JOAQUIN COUP <br /> ENVIRONMENTAL HEALTH DEr'ARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.ora/ehd <br /> �rFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: J ` l L %� Date: <br /> Address: f? City: Zip Code: <br /> Owner/Operator: `"tom Telephone: <br /> Program Element: Progrdrb Record: r7 Inspection Type: <br /> 8180 Posted �l Yes ❑ Rermit Posted J Yes ❑( Re-Inspection on or After: <br /> ki* Wig. OBSERVATIONS AND CORRECTIVE ACTIONS <br /> It <br /> u <br /> � �" Temperature I Item 1 Location Temperature <br /> a <br /> Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: 'F <br /> r, <br /> Exp.Date: Di , re ng Sin 'F uat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: i.1 K Time Out: �� Pag of <br /> I <br /> EHD 16-24 (2^'pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />