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o4g!N c SAN JOAQUIN COUNT <br /> y+ ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> • �q... .a;P. Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.slgov.org/ehd <br /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ( . Date: <br /> Address: 7 City: Zip Code: +L. <br /> Owner/Operator: ✓ Telephone: <br /> Program Element: GProgram Record: V / Inspection Type: <br /> FB180 Posted Yes No Permit Posted _ Yes . No k� Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> ..L��Q..02f�.c�'•c. <br /> 1 <br /> r <br /> C: <br /> T !� <br /> .016-1 <br /> 4 <br /> C <br /> Item/Location Temperature Iteml Location Temperature Item/Location Temperature <br /> 3 <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: 3 "� of Chlorine: ppm Heat: of <br /> Exp.Date: arewashing Sink: of Ouat.Amm.: ppm Other: of <br /> Received By/Title: ' <br /> EH Specialist: Phone: <br /> Time in: Time Out: Page of <br /> EHD 16-24 (2'd pg) 11/2/09 t3,;LY3 JL FOOD PROGRAM OIR CONTINUATION <br />