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SAN JOAQUIN COUP <br /> 2 ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �q., �;P• Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd <br /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facilityta (10: s arc, <br /> Date: <br /> Address: -I e V- LvCity: zip Code: C-1 <br /> Owner/Operator: S� T�Z� Telephone: 3-2_9 _3f •73 <br /> Program Element: Program Record: P R o Sri Inspection Type:IS � w, <br /> 6180 Posted ❑Yes r] Permit Posted 1_ ❑Yes ❑ 1 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS - <br /> _a <br /> a � ,� n Temperature Item f Location Temperature, <br /> .r, _ <br /> Food Safety CertificationFacility Hot Water Temperature Warewashmg ' <br /> Name: Hand Sink: <br /> of !Chlorine: ppm Heat: of <br /> - - ---Exp.Date: arewashing Sink: of �Quat.Amm.: ppm Other: of <br /> Received By/Title: D <br /> EH Specialist: L Phone: <br /> ime in: o ` T Time Out: Q `5 Pagel of l <br /> D vc <br /> EHD 16-24 (21 pg) 413/13 FOOD PROGRAM OR CONTINUATION <br />