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o. °WN SAN JOAQUIN COU Y <br /> � A��z•.cOG <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.segov.org/ehd <br /> �ikoaa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: �3 <br /> Address: / , A City: Zip Code: <br /> Owner/Operator: ( U Telephone: <br /> Program Element: Program Record: 2 2Inspection Type: <br /> SB180 Posted Yes No Permit Posted es No Re-Inspection on or After: l <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> ��1 :.. <br /> - LL <br /> 170-F 77'C <br /> 180'F 82"C <br /> L'o �(�•��.. l Z.I � � e+, ILC 't �`i J � �'i'Z_ •i. L �i i- <br /> Item/Location Temperature Item/Location Temperature <br /> V - <br /> 1�3 g� <br /> -� �rv�,,✓ u� l�7 <br /> ood Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: yl„ Hand Sink: of Chlorine: ppm Heat ^ of <br /> Exp. Date: Warewashing Sink: � of Ouat.Amm.: ppm Other: of <br /> Received By/Title: i <br /> EH Specialist: - 1VW , Phone: /' <br /> Time in: Time Out: ViPageZof <br /> EHD 16.24 (2-pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />