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SAN JOAQUIN COON' <br /> 'gyp..........0 <br /> .OG <br /> X ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.segov.org/ehd <br /> CI FORM <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: n p `1 City:, Zip Code: <br /> Owner/Operator: ` ^ Telephone: 22 _ 422--+ <br /> Program Element: t 2 Progra Record: b 2 , Inspection Type: 7 <br /> 6180 Posted Yes ❑ Rermit Posted 6d Yes ❑ 1 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> L . <br /> M F— c� <br /> ItemlLocataon Temperature Item J LocabW Temperature <br /> 1_91k Q_ I ci <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: v-) Hand Sink: , 1 , of Chlorine: ` ppm Heat: 'F <br /> Exp.Date: _ _ 1 w? arewashing Sink: 1 of Quat.Amm.: ppm Other: 'F <br /> Received )Title: <br /> EH Specialist: Phone: 2 <br /> Time in: S� Time Out: l Pag of 2 <br /> EHD 16-24 (2^d pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />