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SAN .1OAQUIN COUi <br /> �O. .COG <br /> �-+ ENVIRONMENTAL HEALTH DEPARTMENT <br /> N: x X <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.smgov.org/ehd <br /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: — f v Date: c _ ' <br /> ddress: 2 City: Zip Code:ek <br /> Owner/Operator:-7 ` r —� Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> SB180 Posted ❑Yes ❑ Rermit Posted ❑Yes ❑ I Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> - 1 _< <br /> \N 5 _ <br /> o� S - -1 <br /> F121n. c <br /> c kl , <br /> OP <br /> 3 v r`\ <br /> \L ] , <br /> g2 \ <br /> !,Temperature <br /> Food SafetyCertification Facility cility Hot Water Temperature � Warewashing <br /> .. _.._ _ .__- _ ____ �......... <br /> Name: Hand Sink: of Chlorine: v , 1 PPM Heat: ---. _of <br /> Ck <br /> Exp.Date: Warewashing Sink: 'F Quat.Amm.: PPM other: °F <br /> Z <br /> Received By/Title: <br /> EH Specialist: Phone: - - - <br /> ime in: Time Out: S Page of <br /> �- <br /> EHD 16-24 (2n°pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />