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SAN JOAQUIN COUr . f <br /> a ENVIRONMENTAL HEALTH DEPARTMENT <br /> .. X <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax:(209) 464-0138 Web:www.slgov.org/ehd <br /> ��FORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: q o s City: ' r C, 'rZip Code: s 5.7-6 <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> SB180 Posted Yes No Permit Posted - Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> - Fact' I v19j ki <br /> rWe ber Meru + 2 1 NIi") 4 ,4 <br /> 0LOdwre r PI C A Wee <br /> hr M ; cc, l 4or b Ove 3 Move 4 C- C/o 91 <br /> 1 E u _ (p rc• er I Y 5411rvr/ ChiPsv cA is o <br /> �evi o U I n - p erc,, tn re G/1 4 rc <br /> P { <br /> Item/Location Temperature Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature' Warewashing <br /> .._...._.. ___......... _____ .. <br /> Name: Hand Sink: i of Chlorine: ppm Heat: F <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: / a-/e y <br /> Time in: Time Out: Page of <br /> EHD 16-24 (21E pg) 4/9/12 FOOD PROGRAM OIR CONTINUATION <br />