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SAN JOAQUIN COUP <br /> Q` ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.slpov.orq/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: t- Date: !, <br /> Address: q City: Zip Code: <br /> Owner/Operator: b(hurid n_L _ Telephone: �- <br /> 0.5 <br /> Program Element: Program Record: ���U Ins ection Type: <br /> 16 it-,r_80Posted Ve No Permit Posted s No Re-Inspection on or After: <br /> ry <br /> OBSERVATIONS AND CORRECT VE ACTIONS = ' <br /> 7 r <br /> n 02. LLJL— <br /> d GJ yp <br /> 'b <br /> Item/Location _ _1 Temperature Item/Location ,Temperature <br /> a <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: • 4 of Chlorine: ppm Heat: F <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of Il <br /> Received By/Title: <br /> EH Specialist: hone: ?Pq_ O <br /> Time in: Time Out: Page of <br /> i <br /> =HD 16-24 (2^1 pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />