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^a"'"• SAN JOAQUIN COUC_ <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />.o4c%FoA�,e• Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />Address: <br />- <br />City: - <br />Date: <br />Zip Code: <br />Owner/Operator: <br />Program Element: <br />Program Record: <br />Telephone: <br />Inspection Type: <br />SB180 Posted Yes <br />No Permit Posted Yes No <br />Reinspection on or After: <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />.4 Yr G /C4 p. -_-- <br />'GYI (% /'vN 1.'f <br />%'Y"i i 1i<' `.�• .. <br />n <br />(_ <br />Imo_ <br />�.. L..F]/}, /`" <br />C.J- T4` n <br />lit.. �. `•)-- <br />�ItemlLdoallon <br />Temperature <br />" " •aa>. Nem /Location <br />Temperature <br />rJ 171 <br />9`ItioN' <br />�V/' <br />Food Safety Certification <br />Facility Hot Water Temperature <br />Warewashing <br />Name: <br />Hand Sink: <br />`F <br />Chlorine: _ <br />- ppm <br />Heat: <br />OF. <br />Exp. Date: <br />Warewashing Sink: <br />-F <br />Ouat. Amm.:ppm <br />Other: <br />aF <br />Received By / Title: <br />EH Specialist: <br />Phone: <br />Time in: rI <br />Time Out: <br />Page /of r <br />EHD 16-24 (2w pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />