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SAN JOAQUIN COUP. <br /> y+ ENVIRONMENTAL HEALTH DEPARTMENT <br /> H: :C <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> . c... _. :P• Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.s*gov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Q' Date: 77 7 1 7 <br /> Address: City: GAG L Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: I p / Program Rec rd: �f O31SInspection Type: 14"h� <br /> SB180 Posted Yes ❑ No Permit Posted XYes ❑No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS otc <br /> q VVVI Lt a - 3 <br /> 1 IV 10 <br /> Item/Location i4emperature Item/Location Temperature <br /> 37 <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: /,� ` &411—Ilea Hand Sink: ` of Chlorine: ppm Heat: -F <br /> Exp.Date: V arewashing Sink' /, of Ouat.Amm.: ppm Other: of <br /> Received By/ <br /> EH Specialist: Phone: <br /> Time in: r Time Out: (Q Page,�bf Z <br /> EHD 16-24 (21d pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />