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SAN JOAQUIN COUW <br /> L'�SG'•AL , <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> ,S <br /> 600 East Main Street, Stockton, CA 95202-3029 �2 <br /> 4..;. ,.. P Telephone:(209)468-3420 Fax: (209)464-0138 Web:www.siQov.org/ehd <br /> r r <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT / S <br /> Name of Facility: ` Date: 12I Q <br /> Address: /_ . City: �_ Zip Code: 9 <br /> Owner/Operator: . !N _ ele hoe t <br /> Program Element: Program Record: I s ctio Typ : n , <br /> SB18O Posted 0 Yes 0 No Permit Posted 0 Yes 0 No Re-Inspection on or After:�O <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> BT <br /> [ D — <br /> 2 �- <br /> W" <br /> 3 9 INCO- <br /> aWPYC� AA_OtOl� AJ M907- 4e <br /> 3 <br /> OhQ � it I <br /> ttem/Location Temperature Item/Location Temperature Item/Location Temperature <br /> Food Safety CertlifWatbn Facility Not Water Temperature ' Wonewashing <br /> Name: Hand Sink: of hlorine: ppm 11 Heat: of <br /> Exp.Date: arewashing Sink: of uat.Amm.: PPM 10 ther: 'F <br /> Received By I Title: . <br /> E <br /> EH Specialist: Dhone: <br /> Time in: , Time 00t: / 'R'f 1�0 o Page of <br /> 'ssV1' l`9 6 U <br /> EHD 1624(2m pg) 11/2109 FOOD PROGRAM OIR CONTINUATION <br />