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SAN JOAQUIN CiOU1V CY <br /> z ENVIRONMENTAL HEALTH DEPARTMENT <br /> _ 600 East Main Street, Stockton, CA 95202-3029 <br /> d+<IedaH;� Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.sigov.orglehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: r Date: <br /> Address: O City: Zip Code: <br /> Owner/Operator: I ho <br /> Program Element: Program Record: Inspebtion Tjp <br /> 6180 Posted O Yes 0 No Permit Posted 0 Yes 0 No Re-Inspection on or Aker: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> e IfY11-191 <br /> m <br /> 1 <br /> �QTuj S a. DO <br /> O <br /> Q <br /> It <br /> Itern1Location Temperature Item I Location- Temperature Rem I Location Temperature <br /> Food Safety,Certification Facility Hot Water Temperature _ Warewashing <br /> Name: 12 Hand Sink: T aF hlonne: ppm Heat: eF <br /> Exp.Date: arewashing Sink: C/ aF uat.Amm.: ppm her: eF <br /> Received By I Title: <br /> EH Specialist: i I hone: — 6334 <br /> 7. 3 <br /> Time in: V { CD Time Out: a. Page of <br /> EHD 16-23(2°pg) 11I06= c7 FOOD OR CONTINUATION <br />