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SAN JOAQUIN COUP <br />'gyp, ........0 <br />� •.OG <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />.'. 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.smgov.org/ehd <br />4L�FO.tR <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT; <br />Name of Facility: i 1 <br />Date: C <br />Iq <br />Address: <br />City: Zip Code: <br />49.41 <br />Owner/Operator: �- <br />a <br />Telephone: <br />Program Element: <br />Program Record: S-IT2, Z4 <br />Inspection Type: <br />SB180 Posted Yes o <br />Permit Posted Yes No <br />Re -Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />nit <br />Item/Location <br />Temperature <br />Item ! Location <br />Temperature <br />Food Safety Certification <br />Facility Hot Water Temperature <br />Warewashing <br />Name: <br />Hand Sink: /v , <br />of <br />Chlorine: — - ppm <br />Heat: <br />-- --- - F <br />Exp. Date: <br />Warewashing Sink: <br />of <br />Quat. Amm.: ppm <br />Other: <br />of <br />Received By / Title: <br />PC <br />vL <br />EH Specialist: <br />Phone: <br />Time in: C I , <br />Time t: ' 1; 7 5 <br />Page <br />EHD 16-24 (2n1 pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />