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Zip Code:City: <br />Telephone:Owner/Operator: <br />Program Element: <br />NoYesSB180 Posted Yes No <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />/__ <br />TemperatureTemperature’33?; <br />°Fppm <br />Other:Quat. Amm.:Warewashing Sink:°FExp. Date:°F ppm <br />Received By / Title: <br />Phone:EH Specialist: <br />Time Out:Time in: <br />FOOD PROGRAM OIR CONTINUATIONEHD 16-24 (2nd pg) 4/3/13 <br />Warewashing <br />Heat:Chlorine: <br />__ <br />San Joaquin CounW <br />Environmental Health Department <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sjqov.org/ehd <br />Name of Facility: <br />Address: <br />Item/Location <br />__ <br />Food Program Official Inspection Report <br />Date: <br />Facility Hot Water Temperature <br />Hand Sink: op <br />/// 2. {7 / 2- 2L. <br />) <br />Page of <br />Program Record: <br />Permit Posted <br />Inspection Type:_____________ <br />Re-Inspection on or After: <br />Food Safety Certification____ <br />Name: