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oP411N SAN JOAQUIN CO� <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 /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: K4 Date: f 2_12• 1 <br /> Address: Z ` City: �Gn Zip Code: �; �-?� <br /> Owner/Operator: y Telephone: 1 i-7�1Q—'3Er7x <br /> Program Element: � G, + rog am Record: S fz d 9� �^� Inspection Type: n �,(.•-'v <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> - �- h et cis a 4. D Low re - L 5 e c c e+rte <br /> _? r rn i+ . .rXAyrst.3 hen C.c ►�chi-�icm s _ e. <br /> �Fnw.44,n r e rad Lnn PrL,L u ns a rL. r <br /> 12 ne a <br /> o rs a r-C n 1!F ti <br /> t0WR'1- <br /> O�- (.4. 1(Yl <br /> n r o ma.cHu n-. — re Y" o v-e- r»O L-c� - <br /> 6o mt_ A2 r A`- -e 1r' or Yn-i i J l <br /> 74; axAd <br /> -i-T-00 rn-) - U 5 CO qPx—A q 0 rO <br /> on5ariA+ n-}- - <br /> lFs§tL 6n y- 6C n al I <br /> rte— _--_rvD h _._ GL b czo r be r►.+ --- 1'n%t G► Lv 5s -�-n4- <br /> ar- <br /> n <br /> p <br /> R m/Location � Temperature Item/Lavation Temperature <br /> (_e r frof, F <br /> L4 CP <br /> -- ........... -- _.. _........._.__ ... ... <br /> .......- - <br /> --- ----_ <br /> Food Safety Certification Facility Hot Water Temperature g <br /> Name: Hand Sink: F �Chlaorine: m (Heat: F <br /> Exp. Date: arewashing Sink: 'F ut. Amm.: ppm iOther: of <br /> Received By/Title: <br /> EH Specialist. Phone: / _ r� <br /> Time in: Time Out: / Pa e..of Z <br /> EHD 16-24 (2^4 pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />