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SAN JOAQUIN Cf TY <br /> o.... ........o <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 /> ORii <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: �� Date: <br /> Address: City: Zip Code: <br /> Owner/Operator: Telephone: <br /> 6– m <br /> cl <br /> Program Element: Program Record: Inspection Type: <br /> V§71-80 Posted es ❑ Permit Posted yyes ❑1 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 11 D4 <br /> 3 - <br /> �/ i J n4LItJ <br /> U vice <br /> I La <br /> Q ot v <br /> 'facility Hot Nater Temperature <br /> Name: Hand Sink: - � of Chlorine: ppm Heat: 'F <br /> Exp.Date: Warewashing Sink: 'F uat.Amm.: ppmOther: 'F <br /> Received By!Title: <br /> EH Specialist: C Phone: _ <br /> Time in: I'l I W Time Out: I Page of <br /> EHD 16-24 (2n°pg) 4,13/13 FOOD PROGRAM OIR CONTINUATION <br />