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SAN .JOAQUIN COUNT( <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax: (209)464-0138 Web: <br /> www siaoy oro/ehd <br /> ,tiFb'A`� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Date: o3 <br /> p <br /> Name of Facility: C zip Code: <br /> City: w <br /> ddress: Telephone: yJ <br /> wner/Operator: I / <br /> 25 <br /> ro ra Recor In pection Type: e'/.�+. <br /> Program Element: 770, Re-Inspection on or After: <br /> SB180 Posted Yes No Permit Poste -_Yes ❑ No <br /> OBSERVATIONS AND CORRECTIVE ACTION„' <br /> 0 <br /> �w <br /> 1temlLo"'�'-` Temperature Item I Location Temperature Item I Location Temperature <br /> 00 <br /> Food Safety,C Facility Hot Water-Temperature Warewashing <br /> Name: Hand Sink: - I�b of Chlorine: PPM Heat: =F <br /> Exp.Date: arewashing Sink: Y =F uat.Amm.: PPm ther: `F <br /> Received By I Title: <br /> EH Specialist: Phone: <br /> 'Time In: b; Time OLIC r 15 Page of <br /> EHD 16-24 (2i°pg) 4/9/12 l FOOD PROGRAM OIR CONTINUATION <br />