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SAN JOAQUIN COUNTY <br /> �o.•Ty.co <br /> a 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 /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ^ Date: -7— <br /> Address: <br /> 7—ddress: `C`\ 2 , City: , 1 Zip Code: C� 3 <br /> Owner/Operator: �0\7� Telephone: <br /> Program Element: �1� 1 ob Program Record: \ 1 a Inspection Type: <br /> SB180 Posted `U ❑Yes ❑ Rermit Posted D Yes `0'11 1 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> G L <br /> l t <br /> ........... <br /> CLi - �1 - <br /> Temperature Item/Location Temperature; <br /> 3 - <br /> Food Safety Certification Facility Hot Water Temperature �� Warewashing <br /> Name: W QJ�J Hand Sink: of Chlorine: . ppm Heat: .oF,;.. <br /> Exp.Date: 1 _ arewashing Sink:� , 0 of Quat.Amm.: 2`� ppm Other. of <br /> Received By/Title:. - !v 1 CJ C) �� <br /> // <br /> iN <br /> EH Specialist: Phone: <br /> Time in: O `, \ Time Out: 1' V J Page of <br /> EHD 16-24(20c pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br /> C ''-�_ <br /> Is C_Q_ 6 <br />