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SAN JOAQUIN COUr <br /> oP,. ....^ c I 1 <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> cq., ip Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd <br /> ��FO•Ra <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: r � w Date;/ Z,_�_/ <br /> Address: / /ice City: �� Zip Code:9� <br /> Owner/Operator: 7- Telephone: <br /> Program Element: !/�a �j Program Record: �� Inspection Type: <br /> SB180 Posted Yes No Permit Posted e.LXes Ci No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> C' zie <br /> Item/location ' 'temperature Item/Location ) Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: - of Chlorine: Ppm Heat: of <br /> Exp.Date: //��y �_�9 arewashing Sink: of Ouat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone:�� <br /> Time in: /O Time Out: �O Page of <br /> EHD 16-24 (2n1 pg) 4/3113 FOOD PROGRAM OR CONTINUATION <br />