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SAN JOAQUIN COUNTY <br /> y� ENVIRONMENTAL HEALTH DEPARTMENT <br /> W , X <br /> _ 600 East Main Street, Stockton, CA 95202-3029 <br /> • �4.., s•..•;P• Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.segov.org/ehd <br /> �lFdRt� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: _ Date: k <br /> Address: CityLl Zip Code: <br /> Owner/Operator: <br /> Program Element: Program Record: Insp ction T'7 e: <br /> B180 Posted I!Yes n No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS rya4i a, <br /> i <br /> of It <br /> Q Ull <br /> Item/Location Temperature ftem I.Location Temperature Item!Location Temperature <br /> 444, <br /> OF <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: U� .f of Chlorine: - ppm Heat: of <br /> Exp.Date: arewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: ti <br /> H Specialist: Phone: x `b <br /> Time in: V, <br /> Time Out: <' Page/off <br /> EHD 16-23 (20°pg) 07/29/09 , J FOOD PROGRAM OIR CONTINUATION <br />