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C <br />O.P°"'" SAN JOAQUIN COUNT'. <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />•.. _ ;P Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjgov.or /g ehd <br />4��FOR� <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />b �� - <br />e r <br />b y <br />Date: <br />Address: 1� C <br />J <br />! I_ LI c <br />6( v <br />City: <br />r M r <br />Zip Code: <br />C9 s j 7 b <br />Owner/Operator: <br />Telephone: F36 - 0 y <br />Program Element: <br />Program Record: <br />Inspection Type: goo <br />4 <br />SB180 Posted ❑ Yes ❑ No <br />Permit Posted ❑ Yes ❑ No <br />Re -Inspection on or After: <br />o1 <br />Wa4e r <br />tA K <br />0 J 4 4 - <br />a} O <br />i <br />loor; A <br />i <br />.. <br />G <br />f f\ p <br />i/ <br />60rr <br />1 <br />rP ar <br />5 I <br />Item/Location l <br />Temperature <br />Item / Location <br />Temperature <br />Item / Location <br />Temperature <br />Food Safety Certification <br />Facility Hot Water Temperature <br />Warewashing <br />Name: <br />Hand sink: <br />K. <br />of <br />Chlorine:ppm <br />Heat: <br />of <br />Exp. Date:" <br />G i Sink: <br />�� <br />of <br />Quat. Amm.: <br />ppm <br />Other: of <br />Received By I Title: <br />EH Specialist: <br />, <br />Phone: q ,.,3/6 <br />7 �7 <br />Time in: ' �(J <br />Time Out: <br />Page -7_ —, <br />EHD 16-24 (2nd pg) 419/12 FOOD PROGRAM OIR CONTINUATION <br />