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P <br /> SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax: (209)464-0138 Web:www.sioov.oro/ehd <br /> tl FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: } Program Record: Q Inspection Type: <br /> V <br /> 8180 Posted ❑Yes n Permit Posted Yes r I Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Item/Location _ Temperature _Item 1 Location _ .Temperature <br /> ....:. .. <br /> Food Safety Certi£eation "' I; _ 'Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: - 'F Chlorine: - ppm Heat - - 'F <br /> Exp.Date: lWarewashing Sink: 'P Quat.Amm.: ppm ther: 'F <br /> Received B /Title: -r- <br /> EH Specialist:\.-4, ' �-^ _ - Phone: -, <br /> Time in: - _ _ Time Out: ` Cj - Paoe of <br /> EHD 16-24 (2-pg) 413/13 FOOD PROGRAM CF-( ' ;,JATION <br />