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oP4L'" c SAN JOAQUIN COUN <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.slgov.org/ehd <br /> ��FORN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: t1 b do 9 ` Date: <br /> Address: 12 4(j S r- <br /> (1' .(�C) S+ City: S r Zip Code: <br /> Owner/Operator: ;�(ADOSOIvOI`�tJ,vO` Telephone: <br /> Program Element: 110 <br /> Program Record: pp-O b o `0'L� Inspection Type: h p„�TieC^-� <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: f�,�-- <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> SAN i c:¢, SzlrrnQd by w-wi A-I I'b/1 . U b�Iii00 fecaf j*. <br /> C lbw4N "- 3 l,w ve uxI✓ Rax c x S lba+ Vv ime c1 <br /> OVW,,Wea a OCV- S clot r` 0'i <br /> oc`-sta S pkise-Tyed m Roi Sulu". <br /> in t&1 n eS c 1 <br /> f- — g4me CU-00 FDQCA Q <br /> �- �lGtitl-�tiC� U GIQ.r�1 n ft�G�1� <br /> r CGU 1 + a V_ <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> - ------------ - --- <br /> Name: Hand Sink: �F Chlorrine:ine: - ppm Heat: of <br /> Exp. Date: arewashing Sink: F Quat.Amm.: Ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: L�b 9—)—3 4 <br /> Time in: 1� Time Out: Pag of <br /> i <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />