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Zip Code: <br />Telephone:Owner/Operator: <br />Inspection Type:Program Record:Program Element: <br />Re-Inspection on or After:NoPermit Posted YesYesNoSB180 Posted <br />OBSERVATIONS AND CORRECTIVE ACTIONS <br />/ .4 <br />/ <br />7z <br />>■ <br />- <br />Item / Location <br />== <br />Item/Location Temperature <br />Food Safety Certification>'■ » <br />°FppmName: <br />Other:Quat. Amm.:°FWarewashing Sink:ppm°FExp. Date: <br />Received By/Title: <br />Phone:EH Specialist: <br />Page ofTime Out:Time in: <br />FOOD PROGRAM OIR CONTINUATION <br />EHD 16-24 (2nd pg) 4/3/13 <br />Chlorine: <br />Name of Facility: <br />Address: <br />______ <br />City: <br />Facility Hot Water Temperature <br />Hand Sink: <br />,s .. <br />_ <br />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.sjqov.org/ehd <br />Warewashing____ <br />Heat: <br />Food Program Official Inspection Report <br />Date: <br />_______ <br />$