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o. SAN .10AQUIN COU <br /> � .eoG <br /> N: X <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • c... _ ;P• Telephone: (209) 468-3420 Fax:(209)464-0138 Web:www.slgov.org/ehd <br /> 4tjFaRi� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: d�0� <br /> Address: / City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: b © /„ ( Inspection Type: tl h K <br /> 73 <br /> SB180 Posted Yes F, No Permit Posted i Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONSfi ` <br /> tf0 Ian <br /> �. t/ <br /> Item/Location Temperature Item/Location Temperature Item/Location Temperature <br /> - to ---- <br /> AvW p,17 I/ <br /> 791h WftAG <br /> Ar <br /> Food Safety Certification Facility Hot Water T perature Warewashing <br /> 1 14' .— .�._._...-...._._ <br /> Name: h I —M#j Hand Sink. 'F Chlorine: ppm Heat: of <br /> Exp.Date: i 4 0 arewashing Sink: 7,4 of Ouat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: wPhone: _ <br /> Time in: Y� v Time Out: Page f <br /> r o <br /> EHD 16-24 (2nd pg) 4/9/12 FOOD PROGRAM OIR CONTINUATION <br />