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SAN JOAQUIN Cour <br /> 4 Z+ ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> .. } . ;P Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sigov.or /q ehd <br /> 4ciFORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ;.� ��1, �� CWCAM :4 r . I` Date: 1 i2"}j/ 4 <br /> Address: % Cur e-f7� City: S -tLM Zip Code: S Z <br /> Owner/Operator: V + n C/1 I`tvl� Telephone: r1 - I UZ <br /> Program Element: �3 1—Program Record: ��3 � .�1 Inspection Type: 1--i <br /> iSB180 Posted es No Permit Posted Yes No Re-Inspection on or After: �— <br /> µ <br /> OBSERVA'f{flNS'AND CORRECTIVE ACTIONS <br /> 10 <br /> c } 1'r" UIQ <br /> ItemlLocation <br /> L Temperature Item/Location Temperature <br /> _. <br /> Food Safety Certification Facility Hat Water Te Warewashing <br /> Name: Hand Sink: F Chlorine: ppm Heat: F <br /> Exp.Date: Warewashing Sink: °F Quat. Amm.: ppm !Other: 'F <br /> Received By/Title: , 7 <br /> EH Specialist: Phone: <br /> Time in: f 1 { Time Out: (Z, U Page of <br /> EHD 16-24 (211 pg) 4/3/13` TJ FOOD PROGRAM OR CONTINUATION <br />