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" SAN .�OAQUIN COUNTY <br /> O Q <br /> X ENVIRONMENTAL HEALTH DEPARTMENT <br /> _- 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • oq..•..• ,�;o • Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: r ^ Date: <br /> Address: City: j i, Zip Code: 9S' Z 6 <br /> Owner/Operator: Telephone: qb-2 _965 q <br /> Program Element: Program Record: Inspection Type: <br /> SB180 Posted ❑Yes ❑ No Permit Posted ❑Yes ❑ No Re-Inspection on or After: <br /> T _ OBSERVATION$AND CORRECTIVE ACTION <br /> Item/Location Temperature Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot-Water-Temperature Warewashing <br /> Name: Hand Sink: t of Chlorine: ppm Heat: �F <br /> 1� Y1 I <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: it <br /> EH Specialist: Phone: lit <br /> Time in: �S Time Out: �4120 J 0 Page ofZ <br /> EHD 16-24 (2nd pg) 4/9/12 FOOD PROGRAM OIR CONTINUATION <br />