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SAN JOAQUIN COUk (
<br />ENVIRONMENTAL HEALTH DEPARTMENT
<br />1868 East HazeIton Avenue, Stockton, CA 95205-6232
<br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.orcilehd
<br />FOOD PROGRAM OFFICIAL INSPECTION REPORT
<br />Name of Facility: if<0441". a i A Date:
<br />Address: S.. c d 4
<br />City: Zip Code: .„..0t7C—ktiA.)
<br />Owner/Operator:
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<br />96 7 Telephone: - 7o - I 6- .5.1
<br />Program Element: Program Record: Inspection Type: ; i4..? 11)
<br />SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After:
<br />OBSERVATIONS AND coR..F*91-YE:ACTIONS
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<br />siferni!toPPV9n‘' _.Temperature Item / Location -Temperature
<br />. FOod Safety ceriiiicticin Facility Hot Water Temperature , Weiewashin . 9
<br />Name: Hand Sink: oF Chlorine: PPm Heat: °F
<br />Exp. Date: arewashing Sink: .F Ouat. Amm.: ppm Other: °F
<br />Received By / Title:
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<br />EH Specialist: Phone: ..;
<br />ir.Cf—J—e) )1‘11 .r1L__ CL Time in:
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<br />— Time Out: Z..' ,fr Page
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<br />EHD 16-24 (2,4 pg) 4/3/13 FOOD PROGRAM OR COPANDATION
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