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SAN JOAQUIN COUN <br /> N: X <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> . c4.. '�;P• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sl4ov.org/ehd <br /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: W (IJW_� Date: <br /> Address: City: Zip Code: <br /> Owner/Operator: Telephone: S <br /> Program Element: 2� Program Record: /L" Inspection Type: <br /> SB180 Posted Yes ❑ No Permit Posted Yes No 6 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> P�Z 77L, <br /> f <br /> Item/Location Temperature tem l ocation Temperature Item/Location Temperature <br /> CSC <br /> Food Safety Certification Facility Hot wa er Temperature W ashing <br /> Name: ) Hand Sink: v? of Chlorine: ppm Heat. of <br /> Exp.Date: 14 N Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title <br /> EH Specialist: Phone: / <br /> Time in:/ Time Out: Page of <br /> EHD 16-24 (20°pg) 4/9/12 FOOD PROGRAM OIR CONTINUATION <br />