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lil <br />SAN JOAQUIN CM <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br />• �;.. ;P Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sogov.org/ehd <br />L%PORl <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: Cd <br />1, <br />Tc% Imo,_ i c : Date: <br />Address: <br />p d b e City:/'. <br />Poe <br />G C Zip Code: <br />9S j 7-L <br />Owner/Operator: <br />n <br />Telephone: <br />(� / (/, IYZ 2— <br />Program Element: <br />Program <br />Program Record: <br />Inspection Type: <br />Cu f . <br />SB180 Posted Yes No <br />Permit Posted Yes No <br />Re -Inspection on or After: <br />r A:': z0, H&Ar/ Sa I:l i z0, IJ A -1.-, <br />rrrc le et <br />1 brv•o".r^-S r <br />no, S:Ijin f <br />Ccrrec4l <br />a.r !/o,- ; <br />n <br />2 Wee )1S. <br />1 r"c- ,Z-�JOvr� <br />of Ld oitio <br />u; I a/ -v ; <br />AIOo <br />bo; ld-,foC, <br />44" Vn a re a. <br />Cie a I" -/,v 56 <br />P � <br />d ; S Cf- <br />am if fy Re ; l <br />� a C/ <br />,5 ns 0 <br />00/- <br />�� l Self c <br />/ s: <br />6 Rode", df c <br />; ,, S !'Y1 <br />r 0 o r7l A r <br />a. <br />C, Cloy <br />clos <br />0( <br />o <br />C,� <br />Item/Location <br />Temperature <br />Item J Location <br />Temperature <br />-otGo� <br />NSO^ <br />_ <br />Tvuc UGr <br />TJty �, - / :/0 cr <br />41�'/s <br />Food Safety Certification <br />Facility Hot Water Temperature <br />Warewashing <br />Name: t <br />vF� 11Ur1t (;l2S <br />Hand Sink: <br />o <br />�GJC.i F <br />Chlorine: <br />ppm <br />Heat: <br />_ <br />-F <br />Exp. Date: <br />Warewashing Sink: <br />J2 of <br />Quat. Amm.: <br />Ppm <br />Other: <br />of <br />Received By/ Title: <br />EH Specialist: <br />Phone: <br />Wt - <br />Time in:Time <br />J'B <br />Out: <br />Page of s, <br />s <br />EHD 16-24 (2d pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />