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SAN JOAQUIN COUI_ . <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 /> L�FOR� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: J5 Date: <br /> Address: y [�6 G ran J. City: T� Zip Code: <br /> X CG;� P <br /> Owner/Operator: Telephone: <br /> � � <br /> Program Element: 6 G Program Record. Inspection Type: f h / <br /> SB180 Posted Yes 7 No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> �s- &000 <br /> 0, K VU yM-} te- fee-5 v been <br /> Re ufn U f,la0 L a Gm : l <br /> Item/Location Temperature Item/Location Temperature <br /> - ---------------- <br /> Food <br /> --- ---Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: AA'' µ mk: �F Chlorine: ppm Heat: 'F <br /> Exp.Date: Warewashrng Sink: 'F Quat. Amm.: ppm Other: aF <br /> : <br /> Received By/Title: <br /> EH Specialist: �J C� Phone: <br /> Time in: Time Out: 1r Page,of <br /> EHD 16-24 (2n'pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />