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SAN JOAQUIN COUA <br /> X <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �q.. - iP Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.slgov.org/ehd <br /> LiFoaN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: •T ) t Date: 7_ <br /> Address: ve/ City: } cce-nd <br /> Zip Code: 9 S2 3 <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> B180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> fre C iq 11 CA di / <br /> d; s s; hx � s <br /> • r I vv1 a 4 /y <br /> G r l 1 W A �C Ir h A n X 1 S 3 / . / 'iA:n4'i;^ <br /> t rv1 U3 a 4 e r 4 o a be reI tl d ' P e <br /> i U!A t'1 all, i W e <br /> ui Id- u L4 f dpr SG a diS .0e 11 Pr I^ CC4b ^9 4- <br /> Re 000 <br /> ve l,t)G 4rr 4c c/o <br /> s a u s ar u. ,. yrs # rG -fat/ <br /> he - CAir r run i Fir U9F <br /> O o d r m M CA, ✓1 4 G i et r Q4 Q/` <br /> e / 60 yl.F Cc rrecl 4-a da <br /> s s re rt l; erc, 4 r r i .� <br /> P OC4i 2 Wee ll <br /> lin n e /A fps u P /in • , 4. <br /> i nWe e <br /> 3- Coni e S; r1l'� rigs (An61e rnnG4h. /? a ,oC, r lec le' ;.-) <br /> 2 Wee )?s.' <br /> 16 3- CG'-4 1? S; n 1C /Ng 11 s 1 1.<. S l r► f2 a lJ ti /r�, X <br /> Item/Location Temperature Item/Location Temperature <br /> ja V,U i r rF J O G T <br /> s <br /> 4P4 .>1 luh►e _ S F' W (4 l)C-; ,, 14 t <br /> eve N <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: L4 CAI <br /> Sink: i'3 of Chlorine: Ppm Heat: of <br /> tn; 2 <br /> Exp.Date: S Warewashing Sink: of Quat.Amm.: PPM Other: of <br /> Received By/Title: 4 1 I Y <br /> EH Specialist: Phone: 6 <br /> Time in: it //� Time Out: Page of y <br /> of 7r � <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />