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FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: Date: <br />Address: <br />Owner/Operator: <br />City: Zip Code: <br />Telephone: <br />Program Element: Program Record: Inspection Type: <br />SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br />SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East HazeIton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjqov.orgiehd <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />-57 GI 1 ?:( 3 l., 4 i , <br />i N 0 i -ii A L /4 (AD-rip 0 1-- , i d ., <br />i <br />zav (17..)fi <br />I( ( <br />n , f t:-' \ j)z <br />I i , <br />Item/Location Temperature Item / Location Temperature <br />Food Safety Certification 'WNtitity Hot Water Temperature Warewashing <br />Name: Hand Sink: .F Chlorine:Heat: ppm °F <br />Exp. Date: Warewashing Sink: 0 Quat. Amm.: ppm Other: °F <br />Received By / Title: <br />EH Specialist: Phone: <br />Time in: Time Out: Page of <br />EHD 16-24 (2,, pg) 4/3/13 <br /> FOOD PROGRAM OIR CONTINUATION