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" SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax:(209) 464-0138 Web:www.sjcIov.orglehd <br /> Z�FO� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date:L' <br /> Address: City: Zip Code: <br /> Owner/Operator: Telephone: �� } <br /> Program Element: Program Record: Inspection Type--fl <br /> I kA 1 IPI 12r <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORECTI ACTIONS <br /> l <br /> ✓ ✓ <br /> MWCA Ji 1 1 <br /> V�i� Y <br /> t <br /> AA A <br /> l <br /> t <br /> Y-1 IiIi�j 144 <br /> Itern/Location Temperature Item 1 Location Temperature <br /> Food Safety Certificatlon __ Facility Hot Water TemperatureWarewashing <br /> Name: - - Hand Sink: .F .Chlorine; ppm Heat: .F <br /> Exp. Date. arewashing Sink: 'F Quat.Amm.: ppm Other: 'F <br /> Received By/ <br /> EH Specialist: Phone: <br /> Time in: Ael4f Time Out: ':�7 rr Page of <br /> EHD 16-24 (2"`pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />