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SAN JOA UIN COUN <br /> )O•. 'COG "� <br /> �-+ ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sogov.org/ehd <br /> LIFpR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: r— 47-6777777 <br /> —6 77 Date: 2� <br /> Address: 72 City: Zip Code: <br /> Owner/Operator: Telephone: 56,53 <br /> Program Element: e Program Record: D Inspection Type: u <br /> 8180 Posted ❑Yes ❑ Rermit Posted ❑Yes ❑1 9 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> ( <br /> Item/Location .Temperatur Item/Location Temperature <br /> ---....._............-......-......--....... r.--- _... ---- 1. - -... . —..__._.. ...._......_ <br /> land <br /> acilityI Hot Water Temperature WarewashingName: Sink: ofChlorine: ppm ';Heat: of <br /> Exp.Date: ewashing Sink: of Quat.Amm.: ppm I�Other: of <br /> Received By/,Title: <br /> EH Specialist: 7 VV,j e 0 AV G Phone: / g 6 33 <br /> , b r <br /> Time in: 1 CIO, Time Out: 2 Page of <br /> 3 <br /> EHD 16-24 (2"'pg) 4/3113 J FOOD PROGRAM OIR CONTINUATION <br />