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SAN JOAQUIN COUI I' <br /> cZ <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> c+�;Foaa TelePhone:(209)468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> NaFOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> me of Facility: <br /> ddress: Date: <br /> City: Zip Code: <br /> caner/Operator: <br /> ele one: ' <br /> Program Element: Program Record: / S <br /> 8780 Posted Yes D No ( I pe to ype: <br /> Permit Posted D Yes D No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Iq <br /> rs i <br /> 11 f�znoee�4 <br /> `W+n_ <br /> tQ.iL�e -u� 1Y w <br /> f!v <br /> Item/Location _ Temperature Item/Location Temperature- item-/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewash ri <br /> _..- - - ___. __. _ _- - <br /> Name: Hand Sinki: of Chlorine: ppm Heat: ,F <br /> Exp.Date: 'rewashing Sink: -F uat.Amm.: _ PPM then. of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: 49r,V eV yw - Time Cut: h� O Page of ' <br /> EHD16-24 (2-pg) ll&" FOOD PROGRAM OR CONTINUATION <br />