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a�P4 .coc SAN JOAQUIN COUNTY <br /> _ a ENVIRONMENTAL HEALTH DEPARTMENT <br /> e: :a <br /> 600 East Main Street, Stockton, CA 95202-3029 <br /> • cq., cY. Telephone: (209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> 4�cbM1� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Kho III S hoc 1 Date: :4-12 -12 <br /> ddress: (4 SW00C15 ot ucf city: S I li n Zip code: y5:2e 6 <br /> wner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: I 1 ;tl <br /> SB780 Posted 0 Yes 0 No Permit Posted 0 Yes 0 No Re-Inspection on or After: <br /> ERVATIONS AND CORRECTIV <br /> -,r 0 t Tro wsit3 -c/oc r r' ee re r. <br /> ry'a lieCl a <br /> (m; - VS <br /> tA Ise 1 I q1) ' Gr//fOr 135L <br /> I- do rM � C,S- F W -M/r -7 ' <br /> or La Ga blAii1/\ S etjor-late or-lateIrnI10 3 ( AI '. r\ i <br /> ame: A r' I ' t^C) Hand Sink: IvUI aF hlorine: �O ppm eat: U� eF <br /> Exp.Date: I �l arewashing Sink: Y aF uat.Amm.: Ppm her: of <br /> — Al 141Recelved By/Title: ruha <br /> L —.12— Z <br /> H Specialist: Phone: / <br /> me In: l Time Out: U,to f7 Page:;,-of <br /> EHD16-24 (2-pg) 1118/12 J FOOD PROGRAM OIR CONTINUATION <br />