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,oPa •�a� SAN JOAQUIN COUA <br /> : X ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sogov.org/ehd <br /> �lFORt� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: _/�3 Date: 3- /3 <br /> Address: 69 C I,gyp V h,_Lo City: Wt.. Zip Code: p5 3,50 <br /> Owner/Operator: lbr ed Co Telephone: Id 9-2 w_ /0 y <br /> Program Element: Pr gram Record: Inspection Type: u n n� <br /> iSB180 Posted X <br /> Yes CI No Permit Posted XYes ❑No Re-Inspection on or After: �] <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> r k)P Ct 5 -D tt 0-4 <br /> j ri <br /> O <br /> e4 XZt44f <br /> P� <br /> ec) r <br /> E I ° <br /> i Glntee- ' - r T- �jo l�.rL - 43af <br /> Pro,?-5,)A - 10,13° r L -CAo <br /> Vft&_ I n- QL - H I°.P Des t - <br /> .--,p 2oo - <br /> Item/Location Temperature Item/Location Temperature Item! <br /> be.V Ai r 14or, )JI `F sin i L I© y be .4r <br /> vac 2demr 1 ' F Tr6 - I _ Ion <br /> :7 � <br /> ood Safety Certification .Facility Hot Water-Temperature } � .ri> Warewashing co v ri <br /> Name: �L.✓rl.Ve / f'2 Hand Sink: IC%y of Chlorine. ppm Heat: I�LI /'' �F <br /> Exp.Date: /1 arewashing Sink: % of Ouat.Amm.: ` ppm 11 Other: I OF <br /> Received By/Title: / — <br /> EH Specialist: Phone: (7�/bi 3I <br /> br <br /> Time in: q Time Out: (' Page of Z <br /> EHD 16-24 (2°pg) 4/9/12 / FOOD PROGRAM OIR CONTINUATION <br />