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SAN JOAQUIN COU. t <br /> H ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • ��. -:��c• Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.smgov.org/ehd <br /> �%FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: — Date: b - 1& <br /> Address: .ZoO� City: Zip Code: <br /> Owner/Operator: a-(\ Telephone: <br /> Program Element: ` I Program Record: , 1 1 2 Inspection Type: T:: <br /> l <br /> VM61 0 Posted ❑Yes ❑ Rermit Posted ❑Yes ElI Re-Inspection on or After: � <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> ` <br /> 12,S <br /> 2 _T <br /> Item/Location Temperature Item!Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashng <br /> Name: Hand Sink: - 'FChlorine: ppm Heat: F <br /> Exp.Date: arewashing Sink: of uat.Amm.: ppm Other: of <br /> Received By/Title: <br /> Of Ey <br /> EH Specialist:C w L-__ .: ;^ Phone: <br /> �C 6� �-7�.�V �ilr-�--� 1 <br /> Time in: Time Out: `0, Page of I <br /> EHD 16-24(2"d pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />