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�QU°N SAN JOAQUIN COUP <br /> a y+ ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> 04•... �..�;;P Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sigov.or /q ehd <br /> L�FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: l Date: <br /> Address: ko <br /> —S City: Zip Code: <br /> Owner/Operator: Telephone:�� fe76'-�R <br /> Program Element: Program Record: Inspection Type: <br /> SB180 Posted es No Permit Poste��es No Re-Inspection on or After: <br /> a x � :..QBS,ERVA','10NS`AA D�C3RRECT1VEzACT�t3N5 <br /> s.. .:!� ... - <br /> -- <br /> ..............---.......... <br /> - - --- - <br /> c� <br /> _.._.............. <br /> -- -- --- <br /> Item/Location _Tem erature —> Item)Location Temperature <br /> _p __.W <br /> Food Safety Certification Water Temperature Warewashing <br /> Name: Hand Sink: � Chlorinei;2d_, —___, Heat: -F <br /> Exp.Date: / arewashing Sink: of Ouat.Amm.: ppm Other: of <br /> Received B <br /> EH Specilist: Pho 7y �- — <br /> Time in: Time Out: �JJ' O Page of <br /> EHD 16-24 (2n°pg) 4/3+13 FOOD PROGRAM OR CONTINUATION <br />