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SAN .JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> .., s Telephone:{209}468-3420 Fax:(209) 464-0138 Web:www.sjqov.o[g/ehd <br /> '°Lia=psia <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: a �� <br /> Address: f 1u City: Zip Code: <br /> Owner/Operator:, Telephone: <br /> Program Element: Pr ram Record: Inspection Type: <br /> S81 80 Posted C Yes _j No Permit Posted C Yes 3 No LC v Re-inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> /1� 6✓ <br /> ItemlLocation Te!!pwatA ,Item Location Temperature ftem/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Werewashing <br /> Name: Hand Sink: /1 aFChlorine: ppm Heat: -F <br /> Exp.Date: Warewashing Sink: O of Ouat.Amm.: ppm ther: of <br /> Received By/Title: <br /> EH Specialist: yiy� Phone: Cl FYI <br /> Time In: Time Out: Page f <br /> EHD 18-24 (2nd pg) 1118112 FOOD PROGRAM OIR CONTINUATION <br />