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SAN JOAQUIN COUNT) <br /> y+ ENVIRONMENTAL HEALTH DEPARTMENT <br /> %; : :< <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> . c4•.. f_ ;P• Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.siQov.or /q ehd <br /> �f F0t1� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: f/ / Date: <br /> Address: I , City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: ) ,` Prog Record: O! Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATI©NS AND C013RECTIVE AC-nONS : <br /> IF <br /> O _'_f 6 <br /> • /yj r �tl�(tet--P� •70 ,`' <br /> nA. I . ?f7 UW C64 W(t- A) yC_CCy13W 40 4/oci/ <br /> 4 lib-,, tM.I t; ,'ttV --,,W 4a ,`B17 <br /> Ite ocation Temperature Item I Location _ TQmperature <br /> --- _� _.__....---— ------------- , <br /> cHa_ <br /> ateFood Safety Certification - Wr Tmperature, 1Narewashing <br /> Name: Hand Sink: /''1 of Chlorine: ppm Heat: �F <br /> Exp.Date: � ' arewashing Sink of Quat.Amm.: ppm Other: -F <br /> v <br /> Received By/Title: <br /> EH Specialist: Phone: �. --_._.....—_.__...._ <br /> _1-_1____-.-__—----_..__...... <br /> ___- _ <br /> Time in: , / Time Out: \` Page2of Z <br /> EHD 16-24 (2nd pg) 4/3/13 / FOOD PROGRAM OIR CONTINUATION <br />