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a° N SAN JOAQUIN COUI,,./ <br /> Q' ? ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> bac Fea�p. Telephone:(209)468-3420 Fax:(209)464-0138 Web:www.siaov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: tl IDY uSLv Date: I.2 - <br /> ddress: 2 4 U City: rG-l..]-../ 0T) Zip code: <br /> r/Operator4 <br /> wne : �7 tV�1 Telephone q llolo- � <br /> , b <br /> I M ir�jt� <br /> Program Element: I Program Record: PR U r� -.TA-(,o Inspection Type: bl <br /> 3B180 Posted Yes No Permit Posted es No Re-Inspection on or After: <br /> OBSERVATIONS AND CQ CTIVE ACTION <br /> C <br /> 6020 ro (A <br /> 7777 7 "`heriVGocation ' ' Temperature Item/Location Temperature <br /> Food safety Certification Facility Hot Water Temperature Warewashing <br /> Name Hand Sink: of Chlorine: PPM Heat p <br /> xp.Date: arewashing Sink: of uat.Amm.: PP Other: `F <br /> Received By/Title: <br /> H Specialist: ,� Phone: 2; kit ,_ a E 4-q6 <br /> ime in: I - Time Out: /L : I Page of <br /> EHD 1624 (2-Pg) 413'13 FOOD PROGRAM OIR CONTINUATION <br />