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SAN JOAQUIN COUN• <br /> qY <br /> U'6iix� <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: ILL/1-9 (& <br /> Address: City: Zip Code: °15706 <br /> S . <br /> Owner/Operator: -Nom 't _ Telephone: <br /> Program Element: Program Record: pf-0,5 Inspection Type: CJI <br /> SB180 Posted Yes No Permit Posted a No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> ;b (,'\1 <br /> A) <br /> Item/Location Temperature Item!Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: PPM Heat: of <br /> Exp.Date: arewashing Sink: of Ouat.Am .: ppm Other: �F <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> ime in: 11So� v� Time Out: .ZZ Page of <br /> EHD 16-24 (2n°pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />