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Q"'" SAN JOAQUIN COL 'Y /6�ylaao <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ° c .. �P• Telephone:(209) 468-3420 Fax: (209) 464-0138 Web:www.sugov.org/ehd <br /> 4CjFORia <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 1 Date: 0_17 f <br /> Address: / l ^—� O rQ c.n city: Zip Code: <br /> Owner/Operator: Lm v Telephone: 3Z�9� <br /> Program Element: 60 -/bro Program Record: 5 2D Inspection Type: <br /> SB180 Posted es No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> � oo►- wa L( a v'`ecc � �Gc,.� r/cl-�-�- � 1 � <br /> s U l -ay-p— <br /> W3 /-� ra► ' <br /> r4U_ h,r ��h <br /> loon t) <br /> L.e. us in o c,«GCo r, e4---- GC f3 !2 <br /> YO r rn l v <br /> o oe)o -FTU r _ <br /> Item/Location Temperature Item/Location Temperature <br /> W _kY v <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: 6 'na Hand Sink: ��8 of ppm Heat: °F4h Oum <br /> L <br /> Exp.Date: ? <br /> War washing Sink: a� o f Quat.Amm.: ppm Other: 'F <br /> Received By/Title: <br /> EH Specialist: Phone: / <br /> Time in: Time Out: O O, Pagej of <br /> 16 <br /> EHD 16-24 (2^d pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />