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PQu�" SAN JOAQUIN COL Y <br /> � •.OG <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> — __ • 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �4 :P Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.suciov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: u6 "ja C, 13 Date: i:�L - <br /> Address: 5 3 0 Pq utc' /Nv'e— City: S}'C) c Zip Code: <br /> Owner/Operator: "t'L� r I Qtr, Telephone: <br /> Program Element: t� Program Record: n C) 5 15�C� Inspection Type: <br /> I � r'` ��CS LC:fi <br /> SB180 Posted (!,eo No Permit Posted Yew No Re-Inspection on or After: 5 <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> + PfUiV -h L nt Yl.t o <br /> � �ur- �-i � �nsr �&5 - <br /> ir /y L_5 2QUO- <br /> au, <br /> U a l Le ✓ e 1 a <br /> aU '-i'] <br /> Nand-i'tVC, <br /> -E- C vi C.r � <br /> Lit <br /> At f <br /> `j � CLOO r L¢ f <br /> fae- WdLo ►v,— b <br /> 19 litJaW ri Ua 4- I-e >✓ r r r <br /> 6or-4y h D 6i Me- LA0114 B-n 6; <br /> o v <br /> 1 , <br /> D° na c-4 Nn y-e- <br /> fe"e <br /> ItemfLocation Temperature Item/Location Temperature <br /> -- <br /> .2 - ......... ...... <br /> Food Safety Certification _ -- ,1 Facility Hot Water Temperature Warewashing <br /> Name: , Hand Sink: �F Chlorine: ppm Heat: °F <br /> ./fir - - - - --._ -- <br /> Exp. Date: Warewashing Sink: � � of Quat.Amm.: /� ppm Other: `F <br /> Received By/Title:ctwD1 b c 1D <br /> EH Specialist: Phone: <br /> Time in: // <br /> , ' Time Out: !, Page of <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />