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�4P51 'N'•.eo.G SAN JOAQUIN COUNTY <br /> W� <br /> " ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> a°�IPaRN;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: C Date: 12 S <br /> Address: City: Zip Code: <br /> Owner/Operator: '1 G1 f .0 Telephone: <br /> Program Element: `lb ae1 1.Program Record: {�� O Inspection Type: <br /> SB180 Posted Yes Permit Posted es 1 No Re-Inspection on or After: <br /> OBSERVATIONS•AND CORRECTIVE ACTIONS <br /> C ev\iA <br /> Item/Location Temperature - Its I Location .Temperature <br /> Foodlgafety,Certification _ Facility_Hot Water Temperature - Warewa_shing:. <br /> Name: Hand Sink: of Chlorine: PPM Heat: 'F <br /> Exp.Date: arewashing Sink: "F Quat.Amm.: Ppm Other: of <br /> Received By I Title: In Y <br /> EH Specialist: d ! Phone: <br /> Time in: Time Out: Page of <br /> EHD16-24 (20pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />