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SAN .JOAQUIN COUNTS <br /> 2 ' <br /> INVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax:(209)464-0138 Web:www.siaov.Org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: — Date: L <br /> Address: �� City: Zip Code: <br /> Owner/Operator: Telephone: '� <br /> Program Element: Program Record: ' Inspection Type: <br /> B180 Posted D Yes ❑ Remit Posted ❑Yes ❑1 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> tc <br /> G <br /> RA <br /> ✓� <br /> v. <br /> Item/Location <br /> I <br /> Food Safety Certification Facility Hot Water temperature Warewashing. <br /> Name: Mand Sink: Chlorine: . ..PPm Heat: - F <br /> Exp.Date: Warewashing Sink: - - "F IQuat. Amm.: PPM ther: of <br /> I <br /> eceived By/Title: <br /> H Specialist: Phone: — <br /> ime in: Time Out: t Page/ <br /> EHD 1624(2^ pg) 413113 FOOD PROGRAM OR CONTINUATION <br />