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SAN JOAQUIN COUN <br /> ' ENVIRONMENTAL HEALTH DEPARTMENT ; <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> • ... ; Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.s' ov.or /ehd I <br /> �CJFOii� I <br /> I <br /> I <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: n <br /> Date: <br /> ddress: /? City: Zip Code: <br /> Owner/Operator: [ ^ _l elephone: 6197 <br /> Program Element: Program Record: Inspection Type: <br /> SB1 BO PostedYes ❑ No Permit Posted es ❑No Re-Inspection on or After <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Aid <br /> AA A <br /> K- 5tt� <br /> u. A4kAt 6t— Aaf A4Zk& At— ZfZ'l- <br /> � 3 � <br /> S .GAJ R <br /> L5k�gxi�r V <br /> Q hn� ,4 ar <br /> 30 <br /> Item/Location Temperature Item I Location Te rature Item f Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Walrewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: `F <br /> Exp.Date: Warewashing ink: o f Quat.Amm.: ppm Other: -F <br /> Received By/Title-.(4 �Z <br /> EH Specialist: one: XCI 3 <br /> Time in: Time Out: l (i Pag of <br /> EH01Cr24 (2n6pg) 1412 ,'FOOD PROGRAM OIR CONTINUATION <br />