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SAN JOAQUIN COUNTY <br /> P <br /> �+ ENVIRONMENTAL HEALTH DEPARTMENT <br /> to: :. :< <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax:(209) 464-0138 Web:www.s'gov.org/ehd <br /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ' Date: <br /> Address: y \ City: ry Zip Code: a Z-2 <br /> Owner/Operator: J� Telephone: <br /> Program Element: `kQQ l Program Record: 1S 9-- b' <br /> 2-CA <br /> 9 2 Inspection Type: —�L\��Q <br /> F-8-0—posted Yes No Permit Posted Yes ❑No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS. <br /> Item/Location Temperature Item/Location Temperature Item 1 Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewrashing <br /> _..... —._._...._._..-— ---.-.........._............. _... ——- .....—. — _........._....___._ <br /> Name: Hand Sink: of Chlorine: ppm Leat: of <br /> Exp.Date: arewashing Sink: of Quat.Amm.: ppm er: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: ` C Time Out: I ,• — c �J Page;of ` <br /> EH 16-24 (2�pg) 11/2/09 FOOD PROGRAM OIR CONTINUATION <br />