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ot4�'N a SAN JOAQUIN COUNTY <br /> a 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 /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: �- Date: _ =� <br /> Address: '7J--c - City: Zip Code: f' <br /> 17 <br /> Owner/Operator: Telephone: J <br /> Program Element: 1 ;),6 Program Record: Inspection Type: <br /> 6180 Posted Yes [- No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 0. <br /> NomiLocation Temperature non I Location Temperature kern I Location Temperature <br /> Food Safety Certlflatiort Facility lint Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: W=ng Sink: OF uat.Amm.: ppm Other: OF <br /> Received By/Title- <br /> EH Specialist: ./ Phone: r y� <br /> ime in: �• Time Out: �7 t ' � O Page of <br /> EHD 16-23 (211 pg) 11/06/08 �C FOOD OR CONTINUATION <br />