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SAN JOAQUIN COU Y <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> ��FORN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: r I Date: ! _ <br /> Address: y 4LAJ 4tArn m e r Lk, City: Zip Code: <br /> Owner/Operator: I A Telephone: S a- 103Z) <br /> Program Element: No I7 Program Record: (a D5 q a Inspection Type: n <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: I� <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> U t O nr✓-� w n%t 4eX1-he -14 w.e r-P, <br /> corre��-e d . <br /> td(r, ,v p -e rs - Go kl <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of uat.Amm.: v ppm Other: of <br /> Received By/Title: <br /> EH Specialist: ^ Phone: S I <br /> Time in: Time Out: )V_6 <br /> Page of <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />