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SAN JOAQUIN COUN) >I <br />.2� ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />• cq.. �P Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br />�%POFt t� <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />Date: <br />Address: 1 <br />City: Zip Code: <br />Owner/Operator: <br />Telephone: <br />TO— <br />Program Element: („ Program Record: l <br />Inspection Type: 1 <br />SB180 Posted as ❑ No Permit Posted Yes No <br />Re -Inspection on or After: <br />EHD 16-24 (2nd pg) 1/18/12 FOOD PROGRAM OIR CONTINUATION <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />01 <br />�(.�•� <br />e <br />M1 <br />nootIp <br />1 <br />1 <br />Item/Locatian Temperature <br />Item / Location <br />Temperature <br />Item / Location Temperature <br />i <br />o <br />'11,006EPod Safety Certfflcation <br />Facility Hot Water Temperature <br />Warewashing <br />Name: <br />Hand Sink: ! `- <br />of <br />Chlorine: <br />Quat. Amm.:ppm <br />ppm <br />Heat: of <br />Other: of <br />Exp. Date: <br />Warewashing Sink: of <br />Received By/ Title: <br />EH Specialist: <br />one: <br />, Q <br />Time in: ( <br />Time Out: C <br />Page. of <br />EHD 16-24 (2nd pg) 1/18/12 FOOD PROGRAM OIR CONTINUATION <br />