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SAN JOAQUIN COU1, <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone:(209) 468-3420 Fax: (209)464-0138 Web:www.siqov.org/ehd <br /> LrFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: l <br /> Address: City: Zip Code: <br /> OwnerlOperator: Tel o e: W j„ L73 <br /> Program Element: Program Record: s/ Inspecti n yp �Y'j <br /> B180 Posted ❑Yes ❑ No Permit Posted ❑Yes ❑ No 'T Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> CW 3yF - <br /> 0049t 144 <br /> f � <br /> iA <br /> Dom- ' cr <br /> r r . <br /> ttem/Location Tena rature Item I Location Temperature Item I Location Temperature <br /> Food SafetyCertification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: ofChlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: -F Quat.Amm.: ppm then: -F <br /> Received By/Title: <br /> EH Specialist: Phone- <br /> Time in: V 1Time OWL a� ! (l t Page f <br /> EHD 1624 (2W pg) 1 IPJ09 FOOD PROGRAM OIR CONTINUATION <br />