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SAN JOAQUIN COUP? <br /> - ENVIRONMENTAL RONMENTAL HEALTH DEPARTMENT <br /> _ NT <br /> w- 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> cq�1+ i;R�•P. Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.smqov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Fddess <br /> acility: -� <br /> Date: <br /> �+- yJ I , / <br /> City: Zip Code: <br /> . <br /> erator: elephone:lement: / Program Record: <br /> ( � 7 Inspection Type: <br /> SB18U Posted I7 Yes ❑ No Permit posted 0 Yes [] No Re-inspection on or After v <br /> OBSERVATIONS AND CORRECTIVE ACTIONS- <br /> (7. <br /> t►' /: I, 10 11f <br /> 12 <br /> �. <br /> .-JF <br /> 'ar.` r+ W/ <br /> '�<�f 1 <br /> T y <br /> 1Lii�1 <br /> l <br /> i, <br /> L. ti.� L�. /�,�(%r.rZc�_f/ A ' •4f ll ��lLC•f Z+i�"��� <br /> lieMLoca#ion _ p ttertl f Location �, Temperature Item I Location Temperature, <br /> Temperature, <br /> - � Tem erature <br /> Food,Safety Certification Facility Hot Water Temperature... Warewashing <br /> Name: � - Hand Sink: Chlorine: Heat: <br /> t <br /> Lt (. 4 °F PPM °F <br /> Exp.Date: f q Warewashing Sink: 'F Duat.Amm.: PPM Other: 'F <br /> Received By/Title: ` `\y, <br /> EH Specialist: Phone, <br /> { -1 L.� l✓ <br /> Time in: V Time Out: C� - Page of <br /> EHE 16-24 (2nd pg) 419112 FOOD PROGRAM OIR CONTINUATION <br />