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SAN JOAQUIN COW
<br />ENVIRONMENTAL HEALTH DEP TMENT
<br />1868 East HazeIton Avenue, Stockto 'C
<br />3
<br />Telephone: (209) 468-3420 Fax: (209) 464-01 8 Web: www.siqov.orq/ehd
<br />FOOD PROGRAM OFFICIAL INSP TION REPORT
<br />Name of Facility: , .--,••-,%,"x;Z f e").•-e)-7,/
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<br />Address: City: City: Zip Code:
<br />Owner/Operator: _...r, • •••:...,,-2,,....z.„
<br />. Telephone: ............„- „„,
<br />Program Element: V .---, Program Re ord: ,,p_Ack„-- .4-.5.. Inspection Type_, ..... _ __
<br />S6180 Posted Yes No Permit Posted Yes No Re-Inspection on or After:
<br />OBSERVATIONS AND CORRECTIVE ACTIONS
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<br />Item/Location Temperature Item / Location Temperature
<br />Food Safety Certification Facility Hot Water Temperature Warewashing
<br />Name: Hand Sink: .F Chlorine: ppm Heat: °F
<br />Exp. Date: Warewashing Sink: .F Ouat. Amm.: ppm Other: °F
<br />, Received By / Ti . kR:\---z. Yeseritm \it5e_vvve,,
<br />EH Spec' Phone:
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<br />fang,. of Time in: 0; .1 e..) Time Out: / Pap.
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<br />EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION
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