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SAN JOAQUIN COUI <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: voj `�y.tau)/ ` Date: T <br /> Address: �" �� �� /� City: L. Zip Code: <br /> Owner/Operator: 1 lis Telephone: <br /> Program Elemen : PL3 Program Record: Q �'? Inspection Type <br /> SB180 Posted T <br /> Yes No Permit Posted res No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 10,kll-ulc vk-t- 10 cay-ca-zn04 <br /> �vW A4- <br /> yY,,vCc� IJ Get v <br /> to <br /> lcvvK-� rr�{ <br /> "IA 11 h.� v► h fl P — <br /> ViAG d 1 oc of (re Q Xe <br /> Item/LocAfon` Temperature Item/Location Temperature <br /> Zt/Y� 3r YK I d tk"L <br /> Food Safety Certification Facility Hot Water Temperature ,x Warewashing <br /> Name: ���„y�} C'`-� Hand Sink: y, -F Chlorine: ppm Heat: -F <br /> Exp.Date: Warewashing Sink: ✓R1 of Quat.Amm.: ppm Other: of <br /> ' <br /> Received By/Title" <br /> EH Specialist: Phone: _q <br /> L <br /> Time in: bo Time Out: PageZ!f <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />