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• opasliN.-g SAN JOAQUIN COUNTY <br /> via• oc <br /> a' ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax:(209)464-0138 Web:www.sioov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: b u Date: ( -- 3 -- Z <br /> Address: �G - 1 City: zip Code: <br /> Owner/Operator: J \N \ Telephone: <br /> Program Element: ` Program Record: 5 •��—I Inspection Type: <br /> 4A r_Q <br /> SB180 Posted ]Yes n No Permit Posted ❑Yes I No I Re-inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> S 1 eSS-4�6 <br /> CAx ( e S�T <br /> Item/Location Temperature Item/Location 'Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature - Warewashing <br /> Name: Hand Sink: 'F Chlorine: ppm Heat: `F <br /> Exp.Date: arewashing Sink: 'F uat.Amm.: ppm Other: "F <br /> Received By/Title: \ <br /> EH Specialist: Phone: — i_ 16- <br /> Time in: \`^� , Time Out: ,2 Z 12 Pag f <br /> EHD 16.24(2-pg) 419112 FOOD PROGRAM OR CONTINUATION <br />