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O. <br /> P4"'" <br /> SAN JOAQUIN COUN <br /> y-� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • cq.. _ �P• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sl4ov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: , City: Zip Code: <br /> Owner/Operator: •1v Telephone:_`q._Z�`U <br /> Program Element: Program Record: 11'Cr3 q Z Inspection Type: C-C-11t <br /> IS 8180 Posted Yes Permit Posted Yes N Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Nb.w <br /> 5 - - Opw"�_ <br /> Item/Location Temperature Item/Location Temperature <br /> `F <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: 114 OF Chlorine: ppm Heat: �F <br /> Exp.Date: arewashing Sink: OF Ouat.Amm.: ppm Other: �F <br /> Received By/Title: <br /> EH Specialist Phone: <br /> Time in: r;5 Time Out: Page of <br /> U . t <br /> EHD 16-24 (2^'pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />