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pe4tK!"= SAN JOAQUIN CC TY <br /> U� i <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: . Date: <br /> Address: City: Zip Code: C, <br /> Owner/Operator: Telephone: V <br /> Program Element: r ( Program Record: �l 1 Inspection Type: .. <br /> S13180 Posted Yes No Permit Posted Yes C No Re-inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> - <br /> - �� C` I�'} C �. O �1 N'F <br /> u i A 0-r� ON , <br /> V �b <br /> tj c P_ .s ue 1 r <br /> I -7 --7 <br /> ltemlLocation Temperature I Item 1 Location Temperature <br /> _..�....: - --- �------. <br /> I <br /> Food Safety Certification 1 Facility Hot Water TemperatureWarewashing�� <br /> Name: — Nand Sink: F EChlorine: ppm Heat: eP <br /> Exp.Date: Warewashing Sink: F IfQuat.Amm.: ppm ther: o f <br /> Received By 1 Title: <br /> EH Specialist: Phone: <br /> Time in: L Time Out: Pag f <br /> EHD 16-24 (2-pg) 4013 FOOD PROGRAM OIR CONTINUATION <br />