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SAN JOAQUIN COU& <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.segov.org/ehd <br /> ��FORl� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: — L Date: 3 _ 2 L) 3 <br /> Address: 11 S 1 U r Q J U City: � r�,ric h (6 m y Zip Code: 55-.2 / <br /> Owner/Operator:J S' G I n � U r 4 e Vc I al Z' Telephone: Y/ /(" 1 y <br /> Program Element: C1•�� Program Record: 16 ) V ye, Inspection Type: <br /> SB180 Posted I Yes 1 No Permit Posted 1 Yes ❑ No Re-Inspection on or After: ui e e K, <br /> OBSERVATIONS AND CORRECTIVE ACTIONS � �� <br /> 4 e4 <br /> S X ~S U) 01 r /'►'i l.tlof l nr G <br /> go <br /> G7 - A d1'a Q01' A tA l ra <br /> -A hn 5 a h r e, j ke / re <br /> l ; in C k., ? v ; �,? e X <br /> r 1 <br /> P CA n wo <br /> n�s 0 S fro lU K r .� � , /� � ^r U r� <br /> 4 h ; P .1 r Cc ^i1 i {A C Lj rn <br /> i <br /> Q C U 1 Gd r P r l r rti�t <br /> We e KS a f P AS ej0 r1 d CCN r, <br /> M <br /> Item/Location Temperature Item/Location Temperature Item/Location Temperature <br /> .........----- ....__. _ _._.... -..-.._..—___.._._......_.............._..._...._..__..._.._. _._...._.._......_... - —:.._..... ._._...—...-- - <br /> Food Safety Certification Facility Hot Water Temperature Warewashmg <br /> Name: Hand Sink: <br /> c� ,y J, 'F Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Tjte:- C <br /> EH Specialist: Phone: L <br /> Time in: �� Time Out: G' Page of <br /> EHD 16-24 (2°'pg) 4/9/12 FOOD PROGRAM OIR CONTINUATION <br />