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F . <br /> eqq"'N s SAN JOAQUIN COUN i f <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �4tlFda�p.. Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: f OL <br /> Address: City: Zip Code: 1q,5720S <br /> Owner/Operator: �4 Telephone: <br /> Program Element: 1742 1 Program Reco d: sp tion Type: ' <br /> SB180 Posted ,Yes 0 No Permit Posted X Yes 0 No IReinspection on or After: <br /> OBSERVATIONS AND CORRECTIVE'ACTIONS t <br /> Item/Location Temperature I Item I Location Temperature Item 1 Location -Temperature, <br /> bO <br /> Food SafetyCertification Facility Hot Water_Temperature •Warewashing <br /> - Name: Hand Sink: D0 ppm of Chlorine: eat: eF <br /> Exp.Date: V 't 'F Quat.Am m.: PPM ther: >F <br /> Received By/Title: <br /> EH Specialist: Phone:IT <br /> ime in: ,n, b Time Out:k Jf Page of <br /> EHD 16-24 (2-pg) 41112 V 1 FOOD PROGRAM OIR CONTINUATION <br />