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SAN JOAQUIN COUNTY <br /> y+ 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.sjgov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 1'0 0 KS -6 Date: & <br /> Address: 3 G/ Ids y' City: G Zip Code: 45 / <br /> Owner/Operator: a a r Telephon <br /> Program Element: Program Record: ), a Inspection Type: L'n� <br /> SB180 Posted a Yes LNo Permit Posted Yes No /+ Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> IM 12 <br /> n so <br /> e-5 ua L <br /> I K x ne. 0 �X <br /> Item/Location Temperature 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: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: / _ Phone: <br /> Time in: Time Out: �J / Page, of , <br /> e <br /> EHD 16-24 (2^d pg) 1/18/12 FOOD PROGRAM OIR CONTINUATION <br />