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SAN JOAQUIN COL Y <br /> y-+ ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax:(209) 464-0138 Web:www.slgov.orq/ehd <br /> 4��FORa <br /> FOOD PRO RAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: �/ l' a J <br /> Date: ` <br /> Address: - <br /> 7 v1�1 � Z City: (1 L Zip Code: <br /> Owner/Operator: ✓ "` V Telephone: s' <br /> Program Element: 0 Program Record: I `(n Type_v G <br /> SB180 Posted Yes ❑ No Permit Posted Yes - No Re-Insp ction on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> S If <br /> clt(jq W1, Y4 lei <br /> is 04- <br /> u d-e - �c Oef IrV <br /> Item/Location Temperature Item/Location Temperature <br /> . 0 6D✓ q_C? ,_ VI 001 fv� dl " <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: arewashing Sink: of Ouat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: S, I Phone: <br /> Time in: I Time Out: Page of <br /> EHD 16-24 (2nd pg) 4/3/13 ' FOOD PROGRAM OIR CONTINUATION <br />