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SAN JOAQUIN COUO <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.s'oov.org/ehd <br /> 4I FON <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: '2 0( a City: & Zip Code: <br /> Owner/Operator:: Telephone: <br /> Program Element: 0 DO Program cord: "'x ce Inspection Type: 1 <br /> SB180 Posted Yes ll' No Permit Posted Yes No Re-Inspection on or After: YIT <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> vV/ <br /> C e <br /> avid <br /> P/et n <br /> dt oc <br /> IM <br /> ore , . Cf�Yt tt <br /> a� <br /> Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water.Temperature Warewashing <br /> Name Hand Sink: of EChf�rn�- PPM Heat of <br /> Exp. Date: Warewashing Sink: 'F Quat.Amm.: ppm 11 Other: 'F <br /> Received By/Title: <br /> EH Specialist: Phone: _ <br /> !me in: 1 r S Time Out: .b Page of <br /> EHD 1624 (2w pg) 4P 13 _1 v FOOD PROGRAM OIR CONTINUATION <br />