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SAN JOAQUIN COL 'Y <br /> �.•. .�o <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/e <br /> ��FORN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: �,� � j ' ' Date: ZJ/ <br /> 6c4 <br /> Address: City: Zip Code: <br /> Owner/Operator: / Telephone: <br /> Program Element: ,.If r7 Program Record: I Inspection Type: <br /> SB180 Poste Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> ,ZViGri( wWj f^ /''l v JP111n, Me <br /> Lf <br /> ✓'.l lGr Lc � - C h� ��� <br /> S �n hG►,1 GCS plvlGl�r1/`Gt/ f/�[ ✓ <br /> .use �i riF �' �� W I <br /> r mf r� <br /> ItemJLocation Temperature Item J Location Temperature <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 /> EH Specialist: ,rLL Phone: <br /> Time in: ! Time Out: 7h I ( Page,2bf <br /> EHD 16-24 (2nd pg) 4/3113 FOOD PROGRAM DIP CONTINUATION <br />