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4 <br /> ��P FSG SAN JOAQUIN COLOY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 466-3420 Fax:(209) 464-0138 Web:www.slaov.arg/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ; L-e— Date: ' - —1 <br /> Address: \ Z S City: Zip Code: c:� 3 <br /> Owner/Operator: QQ-/C, ham( ��L_t _ Telephone: SQct _ "Ct <br /> Program Element: ,b1+�, Program Record: j`"�� ' Inspection Type: <br /> 6180 Posted 71.Yes ❑ No Permit Posted Yes ❑No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> / Q e <br /> Q0: <br /> Item/Location Temperature Item 1 Location Temperature <br /> Food Safety Certification _ Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: 2CS OFChlorine: ppm eat: OF <br /> Exp.Date: t3 .ZpC_ C areyshing Sink: 131 eF Quat.Amm.: ppm ther: OF <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: Time Out: 1' ZS Page gi 2 <br /> EHO 1&24 (2-pg) A11'3 FOOD PROGRAM 01R CONTINUATION <br />