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SAN JOAQUIN COU& <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 b <br /> . .. Y Telephone:(209)468-3420 Fax: (209) 464-0138 Web:www.sagov.org/ehd <br /> 4LixdRia <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ' �� Date: <br /> Address: b� Zip Code: Q15� <br /> OwnerlOperator: � - Telephone: <br /> Program Element; l R C Program ecord: Inspection Type: <br /> SB180 Posted Yes No J Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> - rn C <br /> - S t- <br /> 2 � <br /> r <br /> l <br /> tom., <br /> Item/Location = Temperature <br /> 1 1 va IflF 2 S3 c= <br /> Facility Hot Water Temperature W as#iing <br /> Name: Hand Sink: "F Chlorine: ppm Heat: of <br /> Exp.mate: Warewashing Sink: of uat. Amm. ppm lo <br /> ther: -F <br /> Received By!Title: <br /> _ W � <br /> EH Specialis#; Nj Ph ne: v <br /> Time in: Time Out: 1 Page M1of I <br /> EHD 16-24 (2"pg) 41313 FOOD PROGRAM OIR CONTINUAT{ON <br />