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O"Qufk SAN JOAQUIN COU �N o�4-c V <br /> ,........ C <br /> Z� <br /> SkVIRONMENTAL HEALTH DEPARTMENTC�-.oat 7(e2-7 <br /> •'. _ __ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> ;p Telephone: (209)468-3420 Fax: (209)464-0138 Web:www.si4ov.orq/ehd <br /> 4�fFORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: O . 1 22lit Date: _5-_10_ I_T <br /> Address: `H 12 20 St rn-a r ie_ Ln, City: C�c+0 C.V_7LOn Zip Code: q S.ZO-7 <br /> Owner/Operator: k_P_ w`' LA-\-/,e K 'X Telephone: _ 5 3�7 <br /> Program Element: I 12- Program rRec' P (Z-O ko-1-7 y Inspection Type:'7n \ 1 rLa <br /> IS 6180 Posted es [IPermit Posted Yes F I Re-Inspection on or After: o <br /> MENZM <br /> BSERVATIONS`AND CORRECTIVEACTIONS <br /> - <br /> � <br /> - con4- -d bin t4-l tic 5 v/"s i <br /> 04 Y- 22- 15 - -1- vis a - 1S p % 1 con-f'o / <br /> Item/Location (Te perature Item/Location Temperature <br /> Food Safety Certification Facility;Hot Water Temperature Warewashing <br /> H <br /> Name: and Sink: _ J of Chlorine:.�.�..__ ppm Heat: of <br /> Exp.Date: arewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: -." <br /> pecialist: / Phone: <br /> ime in: ,/,� T Time Out: ; Pagel of , <br /> EHD 16-24(21"pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />