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°"'" SAN JOAQUIN COUNTY <br /> �9. C°G <br /> 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.s'gov.org/ehd <br /> ��PORC� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: W rr^S Date: <br /> Address: �S S^ UJh City: , Zip Code: —Z <br /> r <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: ti r <br /> SB180 Posted (Yes No Permit Posted es No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm [Heat: of <br /> Exp.Date: arewashing Sink: ofQuat.Amm.: ppmther: of <br /> Received By/Title: Q <br /> EH Specialist: Phone: lD <br /> Time in: Time Out: O 0 1911 <br /> Page of <br /> EHD 16-24 (god pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />