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SAN JOAQUIN COUP . f <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> �IFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: i� Date: 1 <br /> Address: P_ City: Zip Code: <br /> Owner/Operator: L• Telephone: 71 <br /> -7 <br /> Program Element: I Program Record: 1 Inspection Type: <br /> Fil-80—P—osted Yes No Permit Posted -Yes No Re-Inspection on or After: T <br /> OBSERVATIONS AND COR ECTI .EA ONS <br /> -,u zu- av& v <br /> Nllfi ,L- ✓zD <br /> (.( / .'V <br /> a Malr <br /> h10� r <br /> au. <br /> i <br /> l <br /> �s x ,03 w <br /> �o ed <br /> -- <br /> Item/Location Temperature Item/Location Temperature Item/Location Temperature <br /> Food Safety Certificatio Facility Hot Water Temperature - Warewashing <br /> Name: ar}d Sink: of Chlorine: ppm He1.at: F <br /> Exp.Date: / arewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/TH1 <br /> EH Specialist: Phone: `©_� <br /> me in: r Time Out:p" a.�9 1O Page(of <br /> EHD 16-24(2nd pg) 11/2/09 FOOD PROGRAM OIR CONTINUATION <br />