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°��" SAN JOAQUIN COUt <br /> 'o�"� _ <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> . �q.. <br /> �FORM;P Telephone:(209) 468-3420 Fax: (209) 464-0138 Web:www.sogov.org/ehd <br /> � <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: City: Zip Code�3 <br /> Owner/Operator: �. Telephone: <br /> Program Element: "5_ Program Record: rya Inspection Type: <br /> SB 180 Posted-'Yes No Permit Posted�s ❑ No Re-Inspection on or After: <br /> a _ OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 7Z <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashirtg <br /> ----- - - -------- <br /> Name: _ Hand Sink: of Chlorine: ppm Heat: of <br /> i C <br /> Exp.Date: 7� Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: / <br /> EH Specialist: Phone�� <br /> Time in: 7 Time Out: �, "�U Page of <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />