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oPSAN JOAQUIN COUNT, <br /> .y� ENVIRONMENTAL HEALTH DEPARTMENT <br /> N: X <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: 2 f G Date: 2_ _ <br /> Address: DS City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> !SB180 Posted l Yes ❑ No Permit Posted,,�Yes ❑ No Re-Inspection on or After: ` <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> tem/Location % Item!Location Temperature Item l Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: >1 of Chlorine. ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm iOther: of <br /> Received By/Title: J, <br /> EH Specialist: Phone: <br /> Time in: — Time Out: Page of <br /> EHD 16-24 (2° pg) 1112109 FOOD PROGRAM OIR CONTINUATION <br />