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q"l" SAN JOAOUIN COUN': <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 0: X <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> . cq.. _ �p• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.segov.org/ehd <br /> LI PORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> Address: / f City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: / Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No E' Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> � J <br /> Item/Location Temperature Item/Location Temperature <br /> --..__......—......._.......__--- ------- i ---- ------------- -- — -- --------- <br /> Food Safety Certification Facility Hot Water Temperature - Warewashing <br /> Name: Hand Sink: of ChlorineHeat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title <br /> ILZ-aQ <br /> EH Specialist: Phone: �y <br /> ime in: . 'a7 Time Out: g� <br /> a O Pa � <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />