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4"!" SAN JOAQUIN COUNT <br /> X ENVIRONMENTAL HEALTH DEPARTMENT <br /> _= 600 East Main Street, Stockton, CA 95202-3029 <br /> cq., iP Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.si4ov.orq/ehd <br /> �IFORN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: '7 5b t..,,,11 / _W City: Zip Code: f '� <br /> Owner/Operator: S���0�04� Telephone: J <br /> Program Element: �0 Program Record: C^ '791 IV <br /> 33 <br /> Inspection Type: <br /> SB180 Posted /Tes ❑ No Permit Posted /Ves ❑ No J v� Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Item/Location Temperature Item/Location ry` Temperature Item/Location Temperature <br /> Food Safety Ce ca on -_ Facility Hot Water Temperature Warewashing <br /> Name: ' Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: arewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: w^ SCJ <br /> EH Specialist: Phone: <br /> Time in: .` Time Out: 3 i ry / Page of <br /> EHD 16-24 (2ntl pg) 1/18/12I IrFOOD PROGRAM OIR CONTINUATION <br />