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SAN JOAQUIN COU" Y <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �q ........�;iP Telephone:(209) 468-3420 Fax.(209)464-0138 Web:www.sigov.or /q ehd <br /> <<FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Vit, Date: js <br /> Address: 21 SS� �� City: Zip Code: <br /> Owner/Operator: G� /�. Y Telephone: <br /> Program Element: / Program Record: / Inspection Type: <br /> SB180 Poste es 'No Permit Posted /Yes No 1 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> pi 4- <br /> Item/Location i Temperature Item J Location Temperature <br /> -- - <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> _ _ _ _ may.:., ... . _._ <br /> Name: Hand Sink: / 1-7 F Chlorine: ppm Heat: °F <br /> Exp.Date: Warewashing Sink: 'F Ouat.Amm.: ppm Other: 'F <br /> Received By J Title: <br /> EH Specialist: Phone: 70 <br /> Time in: % Time Out: Pae of <br /> EHD 16-24 (2nd pg) 4013 FOOD PROGRAM OR CONTINUATION <br /> 1 <br />