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I 1_11111DIM 4t <br /> SAN JOAQUIN COUNTY <br /> za ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> oR.; _.a�P• Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd <br /> �f FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: — 2 y ` Date: — - <br /> Address: , lil . City: �� Zip Code: G 3 <br /> Owner/Operator: n r Telephone: <br /> Program Element: `V`l_ 00 Program Record: , Inspection Type: 1 H f� <br /> 6180 Posted ❑Yes ❑ Rermit Posted ❑Yes ❑1 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE <br /> Item/Location Temperature `' Item 1 Location Temperature <br /> 2 (� `1 <br /> Cab 1 f= t2 z 1 <br /> w I <br /> Food Safety Certification Facility Hot Water Temperature i Warewashing <br /> Name: ` Hand Sink: of Chlorine: ppm Heat: F <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: `- `oF <br /> Received By/Title: n\ c� �r,A <br /> I w a1 `�... \. Uw3 vJ � v� <br /> EH Specialist: _ Phone: y t_b 1 <br /> Time in: 1 : Time Out: <br /> t 2' 2 O aMa <br /> Page I of <br /> EHD 16-24 (2nd pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br /> S <br />