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ae4�•� SAN JOAQUIN COUNTY <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> • �q., ;o Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.s'gov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: � � c Date: c� <br /> Address: City: Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: , Program Record: t 1_ Inspection Type: (� <br /> SB180 Posted ❑Yes ❑ No Permit Posted ❑Yes r❑J No Re-Inspection on or After: <br /> s OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Item/Locatio Temperature Item/Location Temperature Item/Location Temperature <br /> - - - <br /> Food Safety Certification`., Facility Hot Water Temperature Warewashing <br /> -- <br /> Name: Hand Sink: of Chlorine: ppm Heat: o F <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: aF <br /> Received By/Title: <br /> EH Specialist: ` Phone: 14 1,3 <br /> <3 —��� <br /> Time in: Time Out: ,- -2 Pages pf Lf <br /> EHD 16-24(2nd pg) 11/2/09 FOOD PROGRAM OIR CONTINUATION <br />