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°qAM eon SAN JOAQUIN COUN�'; <br /> y ENVIRONMENTAL HEALTH DEPARTMENT <br /> s 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> �IFOR� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Q a Date: <br /> Address: �� Y�.J City: Zip Code: <br /> Owner/Operator: - Tel 77_ 13.5 <br /> Program Element: Program a ord: z 75 ^� Inspection Type: <br /> SB180 Posted,,/Yes No Permit Posted s No G_ Re-Inspection on or After: <br /> OBSERVATIONS AND <br /> ANNJIMMIMW <br /> IV <br /> t /o <br /> pc ib / - <br /> Item/Location Temperature Item?Location _Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Slnk: of Chlorine: PPM Heat: :F <br /> Exp.Date: arewashing Sink: of uat.Amm.: Ppm ther: eF <br /> Ieceived By/Title: " <br /> H Specialist: Phone: _ —03X <br /> ime in: a- Time Out: / / r Page of <br /> EHD1624 (2-pg) 4/313 FOOD FOOD PROGRAM OR CONTINUATION <br />