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ii <br /> SAN .JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 EAST MAIN STREET,STOCKTON, CA 95202-3029 <br /> TELEPHONE:(209)468-3420 FAx:(209)464-0138 Wee;WWW.SJGOV.ORGIEHD <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> a <br /> ddress:3 Cit Y: f� zip code: S`21�6 <br /> Owner/Operator: hone: <br /> 17 l4 h - Zi` /�li Telephone., <br /> Program Element: Program Record: G <br /> .Op ®� �'� Inspection Type: l� <br /> B180 Posted Yes ❑ No Permit Posted �p�Yes 1)No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> i <br /> Item!Location Temperature Item 1 Location Temperature Item/Location Temperature <br /> Food Safety Certification 7Facility Hot Water Temperature Warewashing <br /> Name: /. LSC Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.pate: �' f0 arewashing Sink: of uat.Amm.: ppm Other: OF <br /> Received By I Title: <br /> EH Specialist: Phone: <br /> ime in: r367 Time Out: ! y Page of ) <br /> EHD 16-23(21 pg) 8114108 / <br /> 08!14!08 F000 OIR CONTINUATION <br />