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SAN JOAQUIN COUO <br /> a ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sipov.org/ehd <br /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: <br /> Date: V_ I --- <br /> Address: - \ City: Zip Code: <br /> Owner/Operator: S` Telephone: <br /> Program Element: \,-J+ <br /> Program Record: `bQ Inspection Type: 1 <br /> 8180 Posted yles ElRermit Posted XYes ❑ 1 Re-Inspection on or After: <br /> //�� OBSERVATIONS AND CORRECTIVE ACTIONS <br /> � v <br /> 7 <br /> � � 1 <br /> 3 Q07C 0 C_�_ <br /> PL� <br /> fety Certification Facility Hot Water T rature Warewashing <br /> Name: Hand Sink: a.� .L of Chlorine: ppm Heat of <br /> Exp.Date: Warewashing Sink: ( 2.2 of Qual.Amm.: ppm Other: of <br /> Received By!Title: <br /> EH Specialist: Phone: "-k <br /> Time in: 10' y 5 Time Out: 11:�S Page�of Z <br /> EHD 16-24 (2otl pg) 4/3/13 FOOD PROGRAM DIP CONTINUATION <br />