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°"!.N <br /> C' SAN JOAQUIN COUNT <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �q., iP• Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sagov.org/ehd <br /> (/FORM ��^► V <br /> FOOD PROGRAM OFFICIAL INSPECTION REPOR cam..-Ic- <br /> Alj <br /> Name of Facility: �, \ —"� Date: — _ <br /> ddress: -ZO,6O 1 1 City: �G Zip Code: S�� <br /> Owner/Operator: V n L�1 Wj Telephone: —102—35---> I _ b 1 <br /> 1� <br /> Program Element: ,( Program Record: ,b 11 r Inspection Type:IS <br /> 6180 Posted V ❑Yes ❑ Rermit Posted ❑Yes ❑I Re-inspection on or After: ��V <br /> g- <br /> - o Psi <br /> \0 <br /> t=- <br /> Item/Loc ati Item 1 LocationTemperature <br /> >. <br /> 53 c u 1 <br /> Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: 1 V 'F Chlorine: ppm Heat: F <br /> Exp.Date: ar wasC.hing Sink- <br /> I � o f at.Amm.: `l � ppm Other: o f <br /> Received By itis: �� '"l <br /> EH Specialist: Phone: kA 1�C� (1 C)z <br /> Time in: 1 1 Time Out: ,Zy VZ� Page—ef ,� <br /> G � <br /> EHD 16-24 (2"tl pg) 413,13 FOOD PROGRAM OIR CONTINUATION <br />