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SAN JOAQUIN COUNI <br /> a ENVIRONMENTAL HEALTH DEPARTMENT <br /> -_ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ��•. �;;P Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> LrFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: City: Zip Code- <br /> Owner/Operator: Telephone: <br /> S <br /> Program Element: Program Record: Inspection Type: rye <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> vti a TION ' 1ND C�RRECTIV AGTIC)I�S <br /> OBS<=RV�1 <br /> rr w <br /> 0f/I v. /a % 1/WvI . 1'it.? c <br /> . ._,. , <br /> �,_ite ocat�on �Tempetature� =� ° � Item!Location, ;= Temperature <br /> Food SafetyCertification ""Facility Hot Water Temperature Warex+ashing <br /> Name: /f 0,V/14 114 Hand Sink: 'F Chlorine: ppm Heat: F <br /> Exp.Date:0q, �a r arewashing Sink: of Ouat.Amm.: PPM Other: of <br /> Received By/Title: <br /> l <br /> EH Specialist: V Phone: <br /> V <br /> Time in: i Time Out: S� Page 7of <br /> EHD 16-24 (2n°pg) 4/3!13 FOOD PROGRAM OIR CONTINUATION <br />