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SAN JOAQUIN COUP <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: t Date: ( �� <br /> Address: \ City: 0r Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> SB180 Posted Yes No Permit Posted ❑Yes ❑No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> ell <br /> r <br /> • <br /> Item/Location i Temperature Item!Location Temperature <br /> --- <br /> 21 <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name. ! )CIO k/ Hand Sink: No-l- <br /> O 'F Chlorine: ppm Heat: 'F <br /> Exp.Date: arewashing Sink: y of Ouat.Amm.: ppm Other: ",F <br /> Received By/Title: - <br /> EH Specialist: Phone: <br /> Time in: ` � Time Out: I, Paggof <br /> EHD 16-24 (20°pg) 4/3/13 L FOOD PROGRAM OIR CONTINUATION <br />