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SAN JOAQUIN COON <br /> 4' Z� 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 /> L�FO� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: r\ ' i- b V\j\ — 1 ,,j--1 Date: ,_ 2 j -- <br /> Address: -�>--s.; n City: c` _ Zip Code: <br /> Owner/Operator: `hp \ -�C V Telephone: S( s <br /> Program Element: > Program Record: S �- Inspection Type: <br /> SB180 Posted es No Permit Posted QLS No Re-Inspection on or After: <br /> OBSERVATIONSAND CORRECTIV ACTItflNS, <br /> ....._.... o Z�C:T, 2=j u � - <br /> ----.........._.._....---......._...._' :LI- T -- V2� SQ \� 5 ,:�.� _--- <br /> 2 _ l <br /> Item/Location Tempefature Item 1 Location Temperature <br /> . --- — -- <br /> Food Safety,Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: dl7QS // ✓ LI _ ________ __ <br /> EH Specialist: lr�I Phone: <br /> Time in: ^S Time Out: f? ` t Page„�of 2 <br /> EHD 16.24 (2n1 pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />