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SAN JOAQUIN COL 'Y <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> Li 6W <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: O 5+o -T-,e-P_ ri C+r- Date: <br /> Address: --I-L6 /(j J f \ City: C Cin Zip Code: <br /> Z <br /> Owner/Operator. Cz O f S1"„v r) Telephone: 6137„912D <br /> Program Element: l l23� Program Record: - .�p' (Z-O 1(O o y`,j $ Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE�ACTIQNS_ <br /> _._ ..... .-- -.— — .__.. _......... <br /> �, ►-►� _ s , w Fe-p- d.v nu+ cit ,tee, 5 e rte( rr..c _._ <br /> ---- --- <br /> . m v-i dR_ ocz of r-of ,_-z_.z r vv,.p <br /> k P7 <br /> 1 , ll--,, <br /> Ll_Q,Lk CVIS i2$�s� -{1 ._......_........Lv_.._._ 3_c ...._.._ ➢ .mak <br /> ,r. v-� cue, r o r'rn o r-»w-t-- r - <br /> rl-A,- +r- <br /> r LL vrt L a c� Ccs►�"-�of <br /> —�+'i ,rtS.. <br /> Si �"� o .� j Q-u - fo w.�ls c g�►_ 57 -,_s r- <br /> r i 4Vd , <br /> Item/Location i Temperature Item 1 Location Temperature <br /> _ <br /> Food Safety Certification Facility Hot Water,Temperature —� Warewashmg <br /> f�yQ� _. �.__.__.------ _._._._._ <br /> Name: Hand Sink: /.z /�/� of Chlorine: ppm H t 'F <br /> _ .1� �yp,Ql!? 1,3a <br /> Exp.Date: areyvat jP ink: _ u of Dmm.: ppm Other: of <br /> L <br /> Received By/Title: <br /> EH Specialist: O r Phone: <br /> Time in: Time Out: Page-;E!-;;IL <br /> EHD 16-24 (2^'pg) 413113 FOOD PROGRAM OR CONTINUATION <br />