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,aP4H'"n.so� SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />•'oq., �a • Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.orq/ehd <br />�FOR� <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT, <br />Name of Facility: <br />Date: <br />Address: <br />✓ City: <br />Zip Code: <br />Owner/Operator: <br />Via EW <br />Telephone: <br />Program Element: <br />P graRecord: b L -k -3 <br />Inspection Type: <br />I V <br />BI80 Posted <br />E Yes D Remit Posted []Yes ❑ 1 <br />Re -Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE.ACTIONS _ <br />-T —LT <br />Item/Locatioq !: Temperature IF <br />'.. Food Safety Certification ? Temperature <br />:. --- --- - ----__ <br />Name: Hand Sink: <br />Exp. Date: arewashing Sink: <br />Item / Location <br />Warewashmg <br />]'F(Chlorine: ppm Heat <br />Qyat Amm.:. PPM they. <br />Temperature <br />of <br />aF <br />Received By I Title:� <br />, l ^n 14/ <br />• l <br />I <br />l• <br />EH Specialist: <br />Phone: r1 it <br />I/V <br />WV <br />/ /i <br />V <br />lo <br />Time in: <br />Time Out: <br />Page <br />EHD 16-24 (2W P@ 0/13 FOOD PROGRAM OIR CONTINUATION <br />