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II <br /> oP41'" SAN JOAQUIN COUNTY <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.siclov.orCl/ehd <br /> qLl PORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: City: Zip Code: <br /> Owner/Operato . O Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No —Ile-inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> G L (.v <br /> a E <br /> 9 � <br /> Ul9 ° <br /> � r <br /> �- <br /> d _ <br /> �►-► " <br /> 1 <br /> Item/Location Temperature Item/Location Temperature <br /> Warewashin <br /> Food Safety Certification Facility Hot Water Temperature _ __-_ g <br /> ---- — —--- —_ - Heat: <br /> Name: Hand—Smk: - °F Chlorine: ppm °F <br /> Exp.Date: I Warewashing s inrk: °F Quat.Amm.: ppm Other: °F <br /> Received By/Title: <br /> EH Specialist: Phone: 42 <br /> ime in: <br /> Time Out: , C Page of <br /> 41 <br /> FOOD PROGRAM OIR CONTINUATION <br /> EHD 16-24 (2n'pg) 4013 <br />