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SAN JOAQUIN COI, Y <br /> X ENVIRONMENTAL HEALTH DEPARTMENT <br /> N: x :< <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.slgov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: I O racl'o I <br /> Date: <br /> Address: '6 Ll C) LCL City: r7 Zip Code: ef ,Sa <br /> Owner/Operator: 7 Telephone: 7flbb <br /> Program Element: 1(.032- Program Record: R O t Inspection Type CVP_0%&O%& 7 <br /> SB180 Posted Yes ❑ Rermit Posted 1�Yes ❑I Re-Inspection on or After: <br /> QBSERVATtONS AN <br /> a CC}RRECTIVE ACTIO <br /> in A, V4 6i I&I �a e) _Pro cry cU b -e <br /> n-k-�-a I A c�CA a lam �s .P. <br /> r -(�loo d deco r- Le r <br /> ka +r> 6.1- <br /> rd -tv Y-e too W,S. "J-.e .c_JCL <br /> .e Un CIA r +,c lite ClyA -4 - l <br /> Lo <br /> Y P r 1D V4 ap— <br /> kL ' c-t <br /> Item/Location Temperature I� Item/Location Temperature <br /> .,T � . _ �..,:: __w �.n..,, <br /> SM l'YL1 I K C,00ln r 3u C 'IP S caY lei r nip l <br /> 4 .IAC c.00(.Q r -- 31 _ _" > c6 C06 GA— - 2 <br /> C4- ffU I IL Goo (2 3ci Z CYOOY CA t, <br /> CAH- I&)f.1 rYr,2 r <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> —Si _.____ F- ——ppm-. eat: _ F <br /> Name: - Hand Sink: o Chlorine. Heat: of <br /> Exp.Date: ,)�� arewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Titl <br /> EH Specialist:-/_ - n �MG 1_ Phone- <br /> ime in: ,I (-); Time Out: l';s D Pagel of <br /> EHD 1624 (2n°pg) 413/13 FOOD PROGRAM IRCONTINUATION <br />