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SAN JOAQUIN COUi_ <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> . cq.. a�P• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.segov.org/ehd <br /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: j 1 Date: {' _J <br /> Address: 1 !2' City: Tr G C Zip Code: 9S j J <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes _ No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> u C I <br /> I + nQr r;A< 1. 0 9 n s <br /> � n I h I S ►rl')rr l <br /> A � n ualet, <br /> I FN1. Io 0 ro, 4v S C4 l G r r J- IC+ <br /> jJ1G C k.5 11 a i r r& �r an 1 an 0( f a ,S <br /> IGuC OS Oro IGr 11C4 tGCJ <br /> 4 C, <br /> G � Inc tyjc �9 <br /> S 0 W AS h h ci n ds n ere le SS W, / 61 <br /> \I) CA3h ho4n s h64n S r) )< , e C a <br /> V11 e 5pre d of b o vt vej [ To les n r <br /> dor. rain S � l rgl . �o - Pu -k <br /> tcd(, cctriyc� 4c <br /> i n Ulf ' 1 - ; n G rA 1V P <br /> r- jee a . 4. J <br /> n V C L, I h N h le. s'JG/ e- <br /> (4 <br /> 0, n i i z e r rerIll' <br /> Item/Location Temperature Item/Location Temperature <br /> S 4e um to ble (- <br /> C I S e V -G ►'' ra r r <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: �< �,�n Hand Sink: of Chlorine: ppm Heat: of LSGr� U _ _ <br /> Exp.Date: _ S Warewashing Sink: :4 of Ouat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: i, / p Time Out: Page.of <br /> V n <br /> EHD 16-24 (2n1 pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />