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P4"'" SAN JOAQUIN COUNTY <br /> �O.�.CGG <br /> ya ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • ..: ;p• Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sl9ov.org/ehd <br /> gCjFORea <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: —�1 Date: _ 2 <br /> Address: City: l r Zip Code: <br /> Owner/Operator: Telephone: ? t^ <br /> Program Element: `b2 Program Record: 'S 1 _ •2 9 2 Inspection Type: J . v <br /> SB180 Posted ❑Yes ❑ Rermit Posted ❑Yes 0 1 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> t <br /> rip <br /> o� <br /> (\ <br /> Le <br /> Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature <br /> Name: 1 q ; Hand Sink: IF Chlorine: ppm Heat: of <br /> Exp.Date: _ 2_ V 2 arewashing Sink: `� eF Quat.Amm.: ppm Other: 'F <br /> Received By/Title: S• \ <br /> EH Specialist: Phone: y <br /> Time in: I Time Out: l 12 Page of <br /> EHD 16-24 (2nd pg) 413/13 FOOD PROGRAM OIR CONTINUATION <br />