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O.�C <br /> P4"'" SAN JOAQUIN COU Y <br /> Q` ENVIRONMENTAL HEALTH DEPARTMENT <br /> W X <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.slgov.orq/ehd <br /> LI FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: -_ v/ k Z1k/ Date: S <br /> Address: City: Zip Code: <br /> Owner/Operator: k/ 9 Telephone: <br /> Program Element: ( 2- Program Record D / �'{.i Inspection Type: <br /> SB180 Poste Yes No G Permit Posted Yes No _I Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> �I V'- <br /> 00 v ✓kk <br /> "slya__- <br /> P;w <br /> kiowzuk, ov rZ, f a c D�� <br /> bow &I r%au\ I <br /> D�• — '� c G`� o� --z 1rrGL � <br /> Item/Location Temperature �p'Item/Location IV Temperature Item i Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: V -1 I)U,lW Hand Sink: L of Chlorine: ppm Heat: / C /� of <br /> Exp. Date: ' arewashing Sink: / of Ouat.Amm.: ppm Other: l� 'F <br /> Received By/Title: <br /> EH Specialis ,/t , v Y Phone: Clk S <br /> ime in: Z Time Out: Pagc?o <br /> EHD 16-24 (2nd pg) 4/9/12 FOOD PROGRAM OIR CONTINUATION <br />