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SAN JOAQUIN COL" .� <br /> ?� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �4t� aaiP• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.slaov.orglehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of facility: <*hAiv/ Date: 5hz 1 <br /> Address: to S. <br /> City: Zip Code: <br /> 4 ZG <br /> caner/Operator: �-c ' -G Telephone: <br /> J I � yluti <br /> Program Element: 'p Program Record: h ��S �� Inspection Type: T <br /> FB 1 BD Posted Yes lr No Permit Posted Yes No Re-Inspection on or After: I <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> V - <br /> 74 <br /> too Qfn <br /> Cw AjV <br /> Oise 07-1 <br /> tteMLocation Temperature --- Item/Lot mperature <br /> Food Safe y Certification Facility Hot Water Temperature:,,,,, Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat. aF <br /> Exp.Date: arewashing Sink: "F uat.Amm.: ppm Other: °F <br /> Received By 1 Title: <br /> EH Specialist: Phone: to %— <br /> ime in: q. uC) Time Out: alAox PagOL'of L <br /> EHD 1&24 (2-pg) 4PNI3 FOOD PROGRAM OR CONTINUATION <br />