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a <br />O.u'" SAN .10AQUIN COUNT <br />P <br />�.CGG <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br />�iFORe� <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />j . <br />Date: <br />Address: 1 5 t /� <br />City: <br />j h Zip Code: G <br />Owner/Operator: <br />Telephone: <br />Program Element: b'7S <br />Program Record: <br />Inspection Type: <br />SB180 Posted Yes No <br />Permit Posted es No <br />Re -Inspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />a" <br />'. f O <br />U <br />ltemlf-ocation <br />Temperature <br />Item / Location <br />Temperature <br />c Sc - <br />y <br />\ <br />Food Safety Certification <br />Facility Hot Water Temperature <br />Warewashing <br />Name: <br />Hand Sink: 10 <br />J <br />of <br />Chlorine: Ppm <br />Heat: of <br />Exp. Date: <br />Warewashing Sink: <br />o f <br />Ouat. Amm.: ppm <br />Other: 'F <br />Received By / Title: <br />EH Specialist: a <br />Phone: <br />Time in: I cy. 2 s <br />Time Out: k OSS �, Page_�of� <br />EHD 16.24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />