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SAN JOAQUIN COUP <br /> • y. Z< ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • c... ;P• Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.s'gov.org/ehd <br /> 4CjFp'�ia <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: �Y� "-� - c Date: 9 <br /> Address— City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: Progr m Record: _0- l ` ( Inspection Type: !?17 i <br /> SB180 Posted Yes No Permit Poste Y No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> e <br /> AA1 <br /> AM ezW;b"f f <br /> r <br /> Lt 14A <br /> " 11 <br /> 062 �5 <br /> A <br /> Temperatur Item/Lo tion Temperature <br /> l am 1144) <br /> Y . <br /> Ir V04672—L2 <br /> r <br /> co <br /> Food Safety Certification Facility Mot Water Temperature Warewashing_ <br /> Name: Hand Sink: 'F Chlorine: ppm Heat F <br /> -- <br /> Exp.Date: arewashing Sink: %`� F Ouat.Amm.: ppm Other: of <br /> Received By/Ti e. c' <br /> �7 <br /> EH Specialist: •-->1— _ Phone: 1r 0 <br /> Time in: 1J Time Out:b Pa f <br /> EHD 16-24 (2na pg) 4313 FOOD PROGRAM OF CO INUATION <br />