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SAN JOAQUIN COLIN <br /> z z ENVIRONMENTAL HEALTH DEPARTMENT <br /> = 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd <br /> �tFOR� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: a Date: w Z3 <br /> ddress: c City: Zip Code: <br /> Owner/Operator: � 7 Telephone: acq <br /> Program Element: Program Record: i 1 Inspection Type: l <br /> 6180 Posted ❑Yes ❑ Permit Posted ❑Yes ❑1'�T r pection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> - - - - - - 1�4 -- - - <br /> VV <br /> V <br /> s r 2 <br /> %, - 1�2 pw <br /> ' <br /> ✓ I Aj efr c <br /> � w r <br /> w <br /> t eAd le ' <br /> V � <br /> I'VI rrMly _4Qrd'I!s 04A `4- � t 4- V AV <br /> y E <br /> Item/Location Temperature Item 1 Location 1 Temperature <br /> - --...._.... <br /> Food Safety Certificationy Hot Water Temperature Warewashing <br /> .... _ �...�.m... _ _ <br /> Name: Hand Sink: aF Chlorine: ppm Heat: F <br /> Exp.Date: arewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> AL <br /> EH Specialist: Phone: <br /> Time in: Time Out: Page of <br /> c <br /> EHD 16-24(2nd pg) 4&113 FOOD PROGRAM OR CONTINUATION <br />