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ate'�'•!Y. fi V SAN JOAQUIN COUNT-' <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 500 East Main Street, Stockton, CA 95202-3029 <br /> •' ��1Foi+'� . Telephone:(209)468-3420 Fax:(209) 464-0138 Web:vwvw.siaoy.orglehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Faciiity: Date: <br /> Address: V1 <br /> City: Zip Code: <br /> Owner/Operator: eiephone: <br /> Program Element: Program Record: Ins tion Type: <br /> iS13180 Posted -1 Yes -jNo / Permit Posted L Yes E No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> ItemlLocation Temperature Item 1 Location Temperature Item 1 Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: ofChlorine: ppm Heat: of <br /> Exp.Date:6W P Warewashing Sink: `F Quat.Amm.: ppm Other: "F <br /> Received By/Title: fb <br /> EH Specialist: ptfoh <br /> Time In: 1 Time . '! Page of <br /> EHD 16.24 (21d pg) 1118112 FOOD PROGRAM OIR CONTINUA ION <br />