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SAN JOAQUIN COUP' <br /> Q` ENVIRONMENTAL HEALTH DEPARTMENT <br /> W :< <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax: (209)464-0138 Web:www.slgov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: V� mal � i ,\V � I (v L Date: /I-'Ir14 <br /> Address: 2S N pun(or-) d City: v'k n n Zip Code: a j5.2_>)6b <br /> Owner/Operator: W Telephone: (�.�,:-h3 SU� <br /> Program Element iCi Program Record: F U'b 1 �G Inspection Type: C�t�(�Q <br /> SB180 Poste Ye No Permit Posted Yes No 1 Ci Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> unc n .w 11 ire <br /> e ' c ��t ��R cif V CCO Whip <br /> Q <br /> -�rykv vc.. P-P-mav t� <br /> QWctr G kA&t INeW "—C— UAW <br /> v u� <br /> `p C- e cAiG'.) r-'�_fi.yft Gr S i-w_ <br /> ltemjL&IiBA7rTett� Item/LocatlOt3 ` Temperature <br /> �n (c <br /> u - In cel 3 "� b��f Qit M Pmt+ CfiT04 i <br /> Faciliiy at" ateeriperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp. Date: Warewashing Sink: of Ouat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: r n ! ^r � /p ii <br /> Time in: Time Out; `tiOU `t T Pag5 <br /> of� <br /> EHD 16-24 (2n0 pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />