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SAN JOAQUIN COUNTY <br /> �o G <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> Y. 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �q•. -.a;P Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.siaov.org/ehd <br /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: e Qu '—Q _ L Date: <br /> Address: 22- City: 1_ 1 Zip Code: S 2�� <br /> Owner/Operator: ACV Telephone: <br /> Program Element: Program Record: �c1 Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No V Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> v <br /> 2 i 3 <br /> 1 H1 <br /> 3 t CI � <br /> 1 (o <br /> 04 - <br /> v t \\ <br /> l <br /> 19 <br /> � 1 ` 1c tc1 —rUs- <br /> Item/Location <br /> Temperature Item/Location Temperature <br /> ro,CA� C-OCA33" <br /> t- 3 ? <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: -F Chlorine: ppm Heat: aF <br /> Exp.Date: Warewashing Sink: 'F uat.Amm.: ppm Other: of <br /> i <br /> Received By/Title: <br /> EH Specialist: P <br /> Time in: S Time Out: `O Page of <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />