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�q. °"�" SAN JOAQUIN COUN <br /> p .. <br /> z ENVIRONMENTAL HEALTH DEPARTMENT <br /> Q: .a <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sagov.org/ehd <br /> �/FOR <br /> FOOD PROGRAM OFF CIAL INSPECTION REPORT <br /> Name of Facility: d I c�S Date: <br /> C <br /> Address: _ ^ City: Zip Code- <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> A101W <br /> SB180 Posted ❑Yes ❑ Permit Posted C Yes ❑I Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 4.. <br /> � t - - <br /> t <br /> c n <br /> A <br /> tno� C <br /> � ^ I <br /> ,r <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Ware was hing <br /> Name: (Hand Sink: of Chlorine: ppm Heat. of <br /> Exp. Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: ^7 Time Out: 1 ^� Page of <br /> r <br /> EHD 16-24 (20°pg) 4/3/13 !J 6 (' FOOD PROGRAM OR CONTINUATION <br />