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o °W" c <br /> SAN JOAQUIN COUP' <br /> � •� oG <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468 3420 Fax: (209) 464-0138 Web:www.sigov.orq/ehd <br /> - FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Dater '45 � <br /> Address: /y Cites_ Zip Code: �3 <br /> Owner/Operator: 7- �•5� Telephone: <br /> Program Element: Program Record: � Inspection Type: <br /> S6180 Posted Yes No Permit Posted,El Yes ❑ No Re-Inspection on or After:,.-- <br /> OBSERVATIONS <br /> fter:/OBSERVATIONS AND CORRECTIVE ACTIONS <br /> �/r i•� - - r to <br /> �.� <br /> G 2 <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp. Date: Warewashing Sink: OF Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist; Phon . OS <br /> Time in: Time Out: ��� Page of Z:> <br /> EHD 16-24 (211 pg) 413/13 FOOD PROGRAM OIR CONTINUATION <br />