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oP41'" SAN JOAQUIN COUNTY <br /> .y, ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sugov.org/ehd <br /> LI Fd� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT, <br /> Name of Facility: Jam ,` Date: r� 1 <br /> Address: City: �' Zip Code: <br /> Owner/Operator: Telephone: y <br /> Program Element: 32-- Program Record: C3 Inspection Type: <br /> SB180 Posted es ' No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> j <br /> Item/Location Temperature Item/Location,, Temperature Item!Location temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> :::: ........._:._ .. ... _._ ..._ . .. _ ::. <br /> Name: �.i Hand Sink: C Y of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: OF <br /> Received By/Title: <br /> EH Specialist: Phone: r <br /> Time in: Time Out: E. Page of <br /> EHD 16.24 (2n°pg) 11/2/09 a FOOD PROGRAM OIR CONTINUATION <br /> f <br />