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c <br /> SAN JOAOUIN COUNA <br /> a <br /> Q` 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 /> ��FORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of FaciliT 77 Date: <br /> Address: Z 6 L�/s V,e City: ^,tjn�Cq Zip Code: 2,5__5 3 <br /> „r /"/ <br /> Owner/Operator: r /\ ` — Telephone: R 3 _ 6_6-7 <br /> Program Element: O Program Record: S 2 Inspection Type: <br /> SB180 Posted a Yes I_I No Permit Posted XYes ❑ No J Re-Inspection on or After: 7` <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> �c ci � S2/l o k GLiaCo L�-lS Ccvt� ��2 �-tom s , <br /> S Sp M7Iva <br /> cl S � Ykt <br /> Item/Location Temperature item/Location Temperature item J Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: %�, j Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Ouat. Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: Time Out: Page of <br /> EHD 16-24 (2^d pg) 11/2/09 FOOD PROGRAM OIR CONTINUATION <br />