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SAN JOAQUIN COUI_ <br /> �° •SAG <br /> W., X ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • •.. z P.app• Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.slgov.orq/ehd <br /> 4�1FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: w � � City:�sy ', Zip Code: <br /> Owner/Operator: �-� /i` Telephone: Z� .-Z-Z <br /> Program Element: (/ PrqgAm ecord: Inspection Type: <br /> 80 Posted s No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> w <br /> .K. <br /> -�P.I e'a � <br /> Item/Location Temperature Item 1 Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: `F Chlorine: ppm Heat: 'F <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: d ,'s-0 Time Out: Page of <br /> EHD 16.24 (2nd pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />