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ro���i"'••.q SAN JOAQUIN CORTY <br />2' ENVIRONMENTAL HEALTH DEPARTMENT <br />\.'.. :.1 600 East Main Street, Stockton, CA 95202-3029 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.s'gov.org/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />Date: — ,Zq— <br />Address: !S <br />City: ^ Zip Code: c2, -A 0 <br />Owner/Operator: <br />u x <br />J P r <br />Telephone: <br />Program Element: <br />\�J L� <br />Program ecord: <br />Inspection Type: , <br />SB180 Posted ).(Yes No <br />Permit Posted Yes No <br />Re -Inspection on or After: <br />EHD 16-24 (2n° pg) 11/2109 FOOD PROGRAM OIR CONTINUATION <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />e_1 <br />k f e G <br />Item/Location <br />Temperature <br />Item / Location <br />emperature <br />Item t Location <br />Temperature <br />Food Safety Certification <br />Name: <br />- 1 <br />I <br />Facility Hot Water Temperature <br />Hand Sink.i�L _ IG �F <br />Warewashing <br />Chlorine: ppm Heat. of <br />Exp. Date: <br />Warewashing Sink: <br />'F <br />Quat. Amm.: ppm <br />Other: °F <br />Received By / Title:o_cl <br />EH Specialist: <br />Time in: l t u <br />7 <br />- <br />Phone: `k <br />�J Time Out: i CJ, J Pageof <br />^� <br />EHD 16-24 (2n° pg) 11/2109 FOOD PROGRAM OIR CONTINUATION <br />