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A <br /> SAN JOAQUIN COUNt� <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.si-gov.org/ehd <br /> r <br /> i <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: <br /> Date: <br /> Address: 5 City: Zip Code: <br /> Owner/Operator: L Telephone: 1e[� , 5 <br /> Program Element: Program Record: Inspection Type: � <br /> f <br /> SBI SO PostedYes 11No Permit Posted ElYes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS _ <br /> 3 <br /> Yin, a <br /> ' I <br /> W An <br /> QW) qac A r., A <br /> + n <br /> r <br /> c f— 41C. <br /> -7L c l <br /> I <br /> Item/Location Temperature Item/Location Temperature Item 1 Location Temperature I <br /> MIJAA <br /> D3� <br /> a <br /> Food Safety Certification Facility Hot Water Temperature Warewashing 1 <br /> Name: Hand Sink: r of Chlorine: ppm Heat: •F J <br /> Exp.Date: Warewashing Sink: �Y of Quat.Amm.: ppm Other: -F I <br /> a <br /> Received By/ <br /> EH Specialist: Phone: t „ <br /> ime in: Time Out: Page7?f <br /> EHD 16-24 (2'"pg) 1/18112 / FOOD PROGRAM OIR COtMNUATiON <br />