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SAN JOAQUIN COUN , <br /> LA ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax: (209) 464-0138 Web:www.s4gov.org/ehd <br /> LrFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: — r Date: <br /> Address: Cit Zi Code: <br /> 31S ,�', j l — Sk Y' P �153 <br /> Owner/Operator: Telephone: �-3 0 . 3 3 6 y <br /> Program Element: Program Record: Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> 11 OBSERVATIONS AND CORRECTIVE ACTIONS11 f� / <br /> tvettr 4h0/ <br /> bGY05, pornrivt ice o A y J\d mcv <br /> `ram ► ta ' La A L 1 „ o, <br /> a r s 40-7te Ve 4 O d^ <br /> SAhiIiz1 ' 2ad h <br /> WOtMet, 140 F TtCAL4IF n l �GCi r 1�NC 11-c✓ (' - -- <br /> IY) ' II rir <br /> Item/Location T Temperature Item/Location i Temperature <br /> rU IS n f oa 3S i'` jraH SP•- �2 l�Or/�-� �l <br /> II: a qI I r,A6 12- doc-) <br /> Tr <br /> _ <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: P Hand Sink: 'F Chlorine: p m Heat: , _ °F <br /> Exp.Date: / }3 - arewashing Sink: of Ouat.Amm.: ppm Other: of <br /> Received By/Title: b / <br /> EH Specialist: Phone: <br /> — ' Jf6d' <br /> Time in: Time Out: I I 1 Page of <br /> EHD 16-24 (2°a pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />