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SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> ai .. <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • Cq., -,��P Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: f <br /> Address: City: Zip Code: <br /> Owner/Operator: n f M Telephone: <br /> i <br /> Program Element: / Program Record: t'/„ , Inspection Type: <br /> SB180 Posted C Yes ElNr o Permit Posted 0 Yes [] No Re-Inspection on or After: <br /> OBSERVt4TE NS AND CORRECTIVE ACTIONS <br /> I - {2p 9 <br /> Gu w y d rce <br /> e �L � <br /> a� ✓ vt a V1 f V, <br /> flvtf�P, <br /> �f l ay v ✓►1tiW(. <br /> u !l <br /> md <br /> AM <br /> !f G d r h <br /> m-e clfl e W r awd <br /> Item&ocation I Temperature I Item 1 Location - __ - Temperature <br /> 14 ww � <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 /> _ <br /> EH Specialist: Phone: t <br /> Time in: f Time Out: 1.7 Pagef <br /> EHD 16-24 (2o0 pg) 413/13 FOOD PROGRAM OIR CONTINUATION <br />