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• oP4"'" SAN JOAQUIN COUNTY <br /> ' ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.siaov.org/ehd <br /> CI Fdk <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: rZ <br /> Address: 22 —if <br /> ah City: H Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: S' Program Record: L S' Inspection Type: <br /> L I <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 6 04 <br /> 2 a� '/w,Seer <br /> k <br /> 'S d <br /> G 62 d <br /> h �, C <br /> 3 �h <br /> V� 42 elhig .%t <br /> - T- <br /> Item/Location Temperature . Item/Location ' Temperature <br /> Food Safety Certification Facility Hot Water Temperature U Warewashing -- <br /> Name: 'Hand Sink: 'F (Chlorine: ppm Meat: -F <br /> Exp.Date: arewashing Sink: eF oust.Amm.: Ppm Other: -F <br /> Received By/Title: <br /> EH Specialist: / Phone: <br /> i ra in: '1III A 114 <br /> Time Out: � Page of <br /> r <br /> EHD16.24 (2^ pg) 4013 FOOD PROGRAM OIR CONTINUATION <br />