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00 <br /> SAN JOAQUIN COON" <br /> ya ENVIRONMENTAL HEALTH DEPARTMENT <br /> X <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> . cq.., ;P• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sjggov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: <br /> ca Date: / 7 <br /> Address: City: lnazdrczz� <br /> Zip Code: <br /> Owner/Operator: Telephone: 44 <br /> Program Element: (0q5Program Record: T a I"Y" 77 ' Inspection Type: f` <br /> B180 Posted Yes No Permit Posted Yes No / Re-Inspection on or After: I <br /> QBSERVATIONS AND CORRECTIVE ACTIONS <br /> sho <br /> 6-4-0— 100patY7 <br /> - D <br /> 04"2L ppryl <br /> Lk <br /> l <br /> V VI <br /> Item/Lonation perature Item 1 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 1 Titi <br /> EH Specialist: Phone: <br /> Time in: /yi I <br /> Time Out: / Page I of3 <br /> EHD 16-24 (2^ pg) A'3113 r/�+, FOOD PROGRAM OIR CONTINUATION <br />