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SAN JOAQUIN COU >( <br /> �O. .COG <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> . �... ;o • Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sogov.org/ehd <br /> 4c/FORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: -_Z <br /> ddress: ' y �^ " City: e _ Zip Code: Q Sy <br /> Owner/Operator: �c Telephone: S, <br /> Program Element: 1 Program Re ord: 1b` ( Inspection Type: <br /> 6180 Posted ❑Yes ❑ Rermit Posted ❑Yes ❑ I Re-Inspection on or After: �� V <br /> OBSERVTIONS AN0 CQ ECTIVE ACTIONS <br /> s 0 <br /> 1 F ck,- <br /> 1 <br /> PhE z-d I— - <br /> Item/Locatio <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: 'FChlorine:- ppm !Heat: F <br /> Exp.Date: arewashing Sink: of uat.Amm.: ppm Other: 'F <br /> Received By/Title: <br /> EH Specialist: _� 1 �\�` Phone: "-A <br /> Time in: q Time Out: ` 2_ Page j <br /> U • �V <br /> EHD 16-24 (2n°pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />