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qu ly <br /> SAN JOAQUIN COU+. i Y <br /> y ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.sjgov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 1,14 ] ( - U Date: <br /> Address: City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: 5 )L Inspection Type <br /> S <br /> I Posted Yes No Permit Posted Yes No c� Re-Inspection on or After: <br /> OBSERVATIONS,AND CORRECTIVE ACTIONS <br /> -7 b a 8T Sal <br /> D <br /> Ic,ru 0 t 0 r144 h 9(qnf <br /> ee;n - r ✓ ' <br /> Item/Location Temperature Item t Co tion Temperature <br /> Foo6Safety Certification Facility Hot Wafer Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date. arewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By!Title. — c <br /> EH Specialist: I <br /> Phone: <br /> (Y <br /> (Y 7 <br /> Time in: , Q Time Out: PagerfZ <br /> EHD 16-24 (214 pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />