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J <br /> SAN JOAQUIN COUNT <br /> ' ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �4....••. ..�;;P Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sjgov.org/ehd <br /> <<FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: O Date: 2- <br /> Address: <br /> ddress: I 33 GA. City: f U Zip Code: C/S �v <br /> Owner/Operator: I�e I✓d TV r-�/�Rl/ & Telephone: <br /> Program Element: 6 Z�o Program Record: o11=0 1 Inspection Type: <br /> IS 8180 Posted ❑Yes ❑ Permit Posted ❑Yes ❑1 Re-Inspection on or After: Tl <br /> .. .. OBSERVATIONS AND CORRECTIVE ACTIONS <br /> ( 4er c� �/ P N o 1'KtsS111 <br /> Item/Location Temperature Item 1 Location Temperature <br /> Food Safety Certification r Facility Hot Water Temperature Warewashing <br /> Sink:Name: _ Hand S _ . .,.r. <br /> (�^� of Chlorine: ppm Heat: °F <br /> Exp. Date: lWarewashing Sink: I Z(D 114__oF Quat.Amm._ ppmOther: °F <br /> Received By/Title '�7 <br /> EH Specialist: t ® , _ Phone: 4401— <br /> Time in: S ) Time Out:2 ,,�� Page /of I <br /> EHD 16-24 (2n0 pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />