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oPa`'`" •� SAN JOAQUIN COUt <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �q..• �;;P Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> �lFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: ,A= <br /> If <br /> Address: City: Zip Code: <br /> Owner/Operato :- Telephone: b <br /> 2 <br /> Program Elemeh. Program Record: �'� Inspection Type: <br /> B180 Posted Yes No Permit Posted Yes kNo i Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> o . <br /> G <br /> Lo <br /> r r <br /> V <br /> D <br /> GI, 91 117 <br /> Item/Location Temperature Item/Location Temperature <br /> ........ <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: }-jam _ �Rrl h Hand Sink: of Chlorine: LjHeat: of <br /> Exp.Date: '� 2 arewashing Sink: of Ouat.Amm.: ther: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: Time Out: �� ;l Page of <br /> EHD 16-24 (2''pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />