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116 <br />SAN JOAQUIN COUNTY <br />a` ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />•.cd.,,, "�„N;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: Date: w-7/ <br />3 <br />Address: <br />City: <br />Zip Code: <br />Owner/Operator: <br />Un <br />Telephone: _ <br />Program Element: ( <br />Program R <br />rd: hC- (+ <br />U� <br />Inspection Type: <br />8180 Posted Yes No <br />Permit Posted Ye No <br />Re -Inspection on or After: <br />"Mc,V k <br />S <br />D.,C <br />RECTIYE,ACTIO <br />h <br />G)(S Pe <br />on, <br />fi► <br />U <br />n <br />r - <br />I . <br />"-—ftem/Location <br />-- ” '=Temperature <br />, <br />'= <br />I <br />Food Safety Certification <br />Name: <br />Exp. Date: <br />Facility Hot Water Temperature <br />Hand Sink: "F Chlorine: <br />arew -Ing Sink: of10 uat. Amm.: <br />Warewashing <br />Ppm Heat: <br />Ppm ther: <br />of <br />of <br />Received B <br />EH Special t: <br />Phone: <br />Time in: <br />Ham <br />Time Out: <br />ir <br />Pag!? o 2- <br />EHD 16-24 (2 -pg) 4313 FOOD PROGRAM OIR CONTINUATION <br />