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SAN JOAQUIN COUR <br /> �O •cGG <br /> �+ ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • ... iP. Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.skgov.org/ehd <br /> '�L1PORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: n OU ,,--y),/ t Date: 6 -� y-13 <br /> Address: I q 12 f+ 5� City: --Frci C Zip Code: Gs ,6 <br /> o �ba-r <br /> Owner/Operator: W Telephone: �3/ yl b <br /> V' $ G J l' <br /> Program Element: 16 Program Record: 1� Inspection Type: <br /> / c12 0 ;"3 <br /> SB180 Posted Yes ❑ No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> L. II V,01e1dr1 ' CC '-rPC4ea. <br /> C O m O IN n 01 facq� eW. <br /> Item/Location Temperature Item!Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp. Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: f — Phone: <br /> Time in: �f 5 Time Out: ': - Page <br /> of <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />