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SAN JOAQUIN COUNTY <br /> "K ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.sigov.orglehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: q171 T-272 <br /> Address: Icity: OU Zip Code: <br /> Owner/Operator: �- �.. s/i Telephone: O .l <br /> Program Element: 16 j 34( Program Record: Inspection Type: <br /> 58180 Posted Yes No Permit Posted Yes o I Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 460 4�i <br /> f ' <br /> it <br /> w <br /> O <br /> c <br /> t <br /> S <br /> r <br /> c <br /> Ite Temperature Item I Location Temperature <br /> Food Safety.Certification Facility Hot Water Temperature WarewashingJ <br /> Name: Hand Sink: 'F Chlorine: ppm Heat: 'F <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: PPM Other: -F <br /> Received By I Title: <br /> EH Specialist: Phone: <br /> Time in: Time Out: f b V Page of <br /> EHD 16-24 (2^O pg) 413/13 FOOD PROGRAM OIR CONTINUATION <br /> PRo I�lo� Z \s" <br />