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C � <br /> ; '9¢4 coo SAN JOAQUIN COLD- TY <br /> z ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1 868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> cQ�fa os�` Telephone:(209) 468-3420 Fax.(209) 464-0138 Web:www.sigov.orglehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: <br /> New <br /> C �/ Date: <br /> Address: City: Zip Code: <br /> Owner/Operator: r,^ Telephone: <br /> Program Element: ,r /7 Program R'eclord: �7 / Inspection Type: r <br /> SB18O Posted Dyes D No Permit Posted []Yes ❑ No [�[,f` Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> I ( <br /> I <br /> &I VU a 0 __t64 a tA fA1 S <br /> (AhYW A 5 ` <br /> +�- r n+-yr rt.; a b _ <br /> 44/it 29 b I( V- ' i <br /> Ir b <br /> f t1 /- ✓ <br /> ' L-- � _ <br /> 9 "AD �- r/ <br /> ( VI cam• <br /> frV yl o <br /> C ✓ ` vT <br /> 1 ✓ _ lJ <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot(Nater Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Ouat.Amm.: ppm Other: of <br /> Received By/Titl <br /> EH Specialist: t , Jn Phone: <br /> Time in: " l.� Time Out: Page of <br /> FHD 16-24 (2M pp) 413/13 FOOD PROGRAM OIR CONTINUATION <br />