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o.PQM,"�o <br /> SAN JOAQUIN COUI t <br /> , . o <br /> 2r ENVIRONMENTAL HEALTH DEPARTMENT <br /> a: .a <br /> = 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209)468-3420 Fax:(209) 464-0138 Web:www.si4ov.orp/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: -T L 1. Date: <br /> Address: City: Zip Code: <br /> `61 .x. S Dorud ,- . , IN C�,,,, , 9S2 <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: RQj C <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS At <br /> II L h 4 C 6 v /u ( ac ; o &4 an <br /> r �l <br /> 2 <br /> U)CI - n �► G r.Qw e nal rGW 1 4crP <br /> abav Feel o- eat far,ds d LA n cr, ✓ r act <br /> S4 1 ra df 4A d ra w m i, b -j a ► ol <br /> W 0 14 Pra evi re . e a 06 d_ 0 ?1 0 fl ,v <br /> 3 natr: 14I 1 '1 ' r ve l-► <br /> c 40 a a n a C l,' 4,1 <br /> Gn <br /> 110 A - a h o. I <br /> 4 I - W o A bin 11S 1. Ir o C/o <br /> e v, h <br /> r (or S r o We L -I - G <br /> h u5 h a Wet //P lG <br /> n er11S. <br /> 6 A'5 C es I r o os vi U C le 5 a r rV1 <br /> 0 4 <br /> Un, -Sex res 4r h h c / W u /I be A ;n o/ <br /> r, Re jq G .r I /\ Woe K <br /> 1 11 r <br /> e -I CcA aro I <br /> � Cc, I - / '� b, t v) � . ✓: <br /> Item/Location Temperature Item!Location Temperature <br /> --- - <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: `F Chlorine: ppm Heat: OF <br /> Exp. Date: Warewashing Sink: OF Quat.Amm.: ppm Other: OF <br /> Received By/Title: <br /> EH Specialist: _ Phone: <br /> Time in: Time Out: Page of <br /> 3 IV <br /> EHD 16-24 (2^d pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />