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° '" • SAN JOAQUIN COUNO <br /> Z ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax:(209)464-0138 Web:www.sioov.org/ehd <br /> �/FORS <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: L) �'} �� Date: ) G •// <br /> Address: '110 <br /> I . 1. {{� . , _ I , City: I r� C Zip Code: <br /> Owner/Operator: W F Telephone: <br /> � �; P r <br /> Program Element: I/J o I Program Ree rd: S / ' {, C' Inspection Type: rr h s <br /> SB180 Posted L.Yes L No Permit Posted :1 Yes No h Re-Inspection on or After: <br /> JL <br /> r' <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> f <br /> ICSS , L/ A <br /> S e a <br /> h0 jorifyCor <br /> tdV, Paper � &W d; rr S <br /> CC4 11ar re- <br /> 1 q K G / u lPs <br /> JC I'ac, i /:N / JP I; n J all <br /> T; I I er C; ,l I I . l 2 i <br /> µ Nem/Loca T p ,erature . Item/Lo Temperature <br /> r\ / <br /> Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: //' of Chlorine: Ppm Heat: of <br /> Exp.Date: Warewashing Sink: . 2 eF Ouat.Amm.: PPM Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: /1 , Time Out: b Page of <br /> EHD16-24 (2-pg) 11/2/09 FOOD PROGRAM OR CONTINUATION <br />