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SAN JOAQUIN COUNO <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone: (209) 468-3420 Fax:(209) 464-0138 Web:www.s'gov.org/ehd <br /> �fFO•R <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: �G Date: f Z <br /> Address: I ) City: <br /> S SS �.)/ Zip Code:_ S � 3 � <br /> Owner/Operator: Telephone: <br /> Program Element: I/ G q_ Program Record: S ? 00 .7 q Inspection Type: Cr n c,1 .U,1 <br /> SB180 Posted Yes No Permit Posted Yes ❑No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS — <br /> 1 oa P r 61 j 120 t. Le,rrt Cc,. <br /> 0 <br /> S . <br /> U V t r' d e V.-Ce On YvS 4foo 17 <br /> Cc, r 1: a, , — 7Xei: 55 1, q 3 / 6 <br /> (4 J LA) cel • n . <br /> Item/Location Temperature Item/Location - Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: ofChlorine: PPM Heat: of <br /> Exp.Date: Warewashing Sink: of Ouat.Amm.: PPM Other: 'F <br /> Received By/Title: r <br /> EH Specialist: Phone: <br /> Time in: Time Out: Page of <br /> EHD 16.24 (2nd pg) 1/16/12 FOOD PROGRAM OR CONTINUATION <br />