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x'0�'4 SAP JOAQUIN COUN <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �t� d fi;�• Telephone: (209) 468-3420 Fax:(209)464-0138 Web:www.s'gov.orq/ehd <br /> j, r n t r <br /> OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> 92 <br /> Address: City: Zip Code: <br /> Z <br /> Owner/Operator: V Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: V <br /> OBSERVATIONS AND CORRI=CTIVE ACTIONS <br /> 44 <br /> np <br /> cam. V c AA, <br /> Item/Location Temperature Item I Location Temperature <br /> _ Food Safety Certification __ Facility Hot Water_T_emperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppmeat: eF <br /> Exp.Date: Warewashing Sink: aF Ouat.Amm.: ppm ther: of <br /> Received By 1 Title: <br /> EH Specialist: Phone: <br /> Time in: Time Out: , IS � Page. of <br /> END 16-24 (21'd pg) 413113 FOOD PROGRAM OR CONTINUATION <br />