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aqT <br /> 40'i� .�oG SAN .10AQUIN COU►._ <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> .. P Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ->. Date: R _ 3� I <br /> Address: City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: ( q Program Record: S Z 2 Inspection Type: S 4 <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS1 <br /> 17 S <br /> le S - <br /> 3 2fl �,_xj x n C <br /> �- Z—N3c' <br /> w - <br /> u ► <br /> Item/Location TTemperat.ure Item/Location Temperature <br /> Food Safety Certification L Facility Hot Waller Temperature_ Warewashing <br /> Name: Hand Sink: F Chlorine: ppm Heat: 'F <br /> - -- - <br /> Exp.Date: Warewashing Sink: .F puat.Amm.: pp m Other: F <br /> I <br /> Received By 1 Title: Wr - <br /> EH Specialist: t �) lJPhone: b _ <br /> Time in: —, F , �,^� {� Time Out: Page of <br /> EHD 16-24 (2m pg) 413113 V FOOD PROGRAM OIR CONTINUATION <br />