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" SAN JOAQUIN COU Y <br /> 'o •• . ......c <br /> � •.OG <br /> .Z� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.siqov.orp/ehd <br /> �iFoaa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: r, Date: <br /> Address: —� City: Zip Code: <br /> Owner/Operator: C ) � G� Telephone: LQ <br /> Program Element: - ']�� Program Record: ® �2 Inspection Type: <br /> y/UW1 <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> VLU YQ <br /> -- <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: PPM Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: VY�� Phone: ,q <br /> Time in: t Time Out: l J Page of <br /> EHD 16.24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br /> q <br />