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SAN JOAQUIN CC JTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> N: X <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • ... ;P.. Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.s*gov.org/ehd <br /> '9L�FORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: N Date: • C <br /> Address: 1��2 City: S L Zip Code: c 2-6 Lo von n 0 t vur �t Telephone: C. ' l 6 <br /> Program Element: C - 1 , Program Record: i?Q G�IV)j � C L(jU -1 � �j Inspection Type:iJ t <br /> SB180 Posted Yes o Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> VD , <br /> QVL tAUCAAIi Cif <br /> U� •vJ <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Ouat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: n _ <br /> Time in: L U(J Time Out: I2, Page of <br /> EHD 16-24 (2n"pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />