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�o�4 .coG SAN JOAQUIN COUNT>< <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> _= 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> ��FOtza <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: City: Zip Code: J- <br /> Owner/Operator: Telephone: r _ Y <br /> Program Element: / 2.6 Program Record: D 2 Inspection Type: <br /> SB180 Posted ❑Yes ❑ No Permit Posted ❑Yes ❑ No l� J Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> cam►-, <br /> x - - <br /> P�titi. ,r <br /> Item/Location Temperature Item!Location Temperat a Item!Location Temperature <br /> Food Safety Ce ification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: - Of <br /> 1�� <br /> EH Specialist: , Phone: D��1 <br /> Time in: Time Out: 4 a D— Page of <br /> EHD 16-24 (2nd pg) 11/2/09 FOOD PROGRAM OR CONTINUATION <br />