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ENVIRONMENTAL HEALTH DEpgR� <br /> _ <br /> Y. 1868 East Hazelton Avenue, Stockton, CA 95205-g23 <br /> PTelephone: (209)468-3420 Fax: (209) 464-0136 Web:www.s;aov n�n�a <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: I <br /> ` City: Zip Code- <br /> Telephone' <br /> ddress: -J <br /> OwnerlOperator: 1 1zr � „ <br /> !n ction Type: <br /> Program Element: Program Record: dv <br /> SB188 Posted es <br /> El No Permit Posted Yes o <br /> Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> c k" <br /> 111 4, <br /> rr` <br /> ItemlLocation Temperature <br /> Item I Location Temperature Item I Location Temperature <br /> Warewashing <br /> Food Safety Certification Facility Hot Water Temperature Heat: °F <br /> Hand Sink: °F Chlorine: ppm <br /> Name: Other: <br /> Exp.Date: °F <br /> arewashing Sink: °F Quat.AMM.: ppm <br /> Received By I Title: / f <br /> 42 Phone G a <br /> EH Specialist: Page of <br /> Time Out: I .� <br /> Time in: <br /> FOOD PROGRAM OIR CONTINUATION <br /> EKD 16-24(2nd p9) 0112 <br /> �agc i ui <br />