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at+Au1H. SAN .JOAQUIN COUNIR <br /> a•�Fpm <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> • �dY1sANti�p. Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: S- ` Date: <br /> Address: ✓ City: w <Y Zip Code: <br /> i <br /> caner/Ope ator: Telephone:S l a� <br /> Program Element: Program Record: ` fn Inspection T e• <br /> !�<V <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or Aker: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> u li II �`� <br /> ar <br /> a c i� avr k <br /> kAlt <br /> a It <br /> t v (f- ave 1 <br /> /' ya <br /> ttemlLocation Temperature Item/Location Temperature Item/Location Temperature <br /> y, r <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: PPM Heat: of <br /> Exp.Date: arewashing Sink: of �Quat.Amm.: PPM Other: of <br /> i <br /> Received By/Title: <br /> EH Specialist: Phone: pwc <br /> Time in: - Time Out: Page of <br /> EHD 1623 (2- pg) 11/06/08 FOOD OR CONTINUATION <br />