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SAN JOAQUIN COUP <br /> y+ ENVIRONMENTAL HEALTH DEPARTMENT <br /> = 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: ? <br /> Address: f S' — City: Zip Code- <br /> Owner/Operator: Telephone: <br /> Program Element: I & 2 I Progr&fi Rec d: /11 Inspection Type: f, <br /> B180 Posted Yes ❑ Rermit Posted Yes ❑f Re-Inspection on or After: <br /> s, OBSERVATIONS AND CORRECTIVE ACTIONS <br /> v - <br /> A7 a, ,,. Temperature <br /> , <br /> r f <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> __ _ l y of Water - <br /> Name: �HanclSink: of Chlorine: ppm Heat: F <br /> Exp.Date: rewashing Sink: 'F Quat.Amm.: ppmOther: of <br /> Received By/Title <br /> EH Specialist: Phone: <br /> Time in: rl Time Out: age of P <br /> EHD 16-24(2nd pg) 4/3/!1/3 FOOD PROGRAM OIR CONTINUATION <br />