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SAN JOAQUIN COUNIFY <br /> ur X ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sogov.org/ehd <br /> �I FORD <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: / Date: L. <br /> Address: ( City: AZip Code: <br /> G— <br /> Owner/Operator: Telephone: <br /> Program Element: 1 Program Record:) o �' ( , Inspection Type: <br /> SB180 Poste Yes ❑ No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> © ;u 1411 u Ll a pe- <br /> to (J k-1 h J74-yv i <br /> ''1 J�'► N - R v J <br /> v- v h X14 ovt <br /> - a 0 1(yJ <br /> C (0 W ✓`C. <br /> C( <br /> 1 IrYvw w n - <br /> Item/Locatio' — ' Temperature item/Location Temperature <br /> C r c Vq — <br /> Food Safety Certificationjr6. Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: F Chlorine: ppm Heat: F <br /> Exp. Date: Warewashing Sink: �F Ouat. Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: Time Out: t D PageLofz <br /> EHD 16-24 (2k pg) 4/3/13 1FOOD PROGRAM OIR CONTINUATION <br />