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SAN JOAQUIN COUR <br /> N: <br /> X ENVIRONMENTAL HEALTH DEPARTMENT <br /> c :< <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> c,. r �p Telephone:(209)468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> , <br /> L/FORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: O Inspection Type: 7'ca 'r—f t <br /> K8-0posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> C U <br /> act <br /> r <br /> Y�~ <br /> 00 '(O r <br /> cl <br /> .ram <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: Gy <br /> Time in: c1qO Time Out: ! /� J Page of <br /> EHD 16-24 (2nd pg) 4/3/13 ! FOOD PROGRAM OIR CONTINUATION <br />