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A SAN JOAQUIN COUNTY <br /> 9. <br /> =X ENVIRONMENTAL HEALTH DEPARTMENT <br /> -_ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.s ov.or /ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: <br /> QL Yt Gt Yk Date: <br /> Address: �! [ ( Cit p <br /> Y- Zi Code: <br /> OwnerlOperator: Telephone: <br /> tit t�G� U <br /> Program Element: V Program Record: ! ' Inspection Type: <br /> I .y(Gtti y. <br /> Sal 80 Posted ❑Yes E Rermit Posted ❑Yes ❑ 1 Re-inspection on or After: <br /> OBSERVATIONS ANIS CORRECTIVE ACTIONS <br /> VI)AI 1v `t t�t_ cid �t <br /> kemfLacation Temperature Item t Location Temperature <br /> Food Safety Certificlabon Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp. Date: arewashing Sink: of Quat.Amm.: ppm Other: <br /> ReceivedBy I Title: <br /> EH Specialist: f Phone: - <br /> irre in: Time Out: j 1s /� PageloY7 <br /> EHD 16-24 (2^ pg) 413113 l V FOOD PROGRAM OIR CONTINU/A✓TION <br />