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PqurN SAN JOAQUIN COUt <br /> :[ <br /> 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.sipov.org/ehd <br /> �rFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: t el-rv'e' Date: 9 <br /> Address: j� G , City: Zip Code: <br /> Owner/Operator: 1 P, n_e n Telephone: <br /> Program Element: till �9-�) Program Record: CIO / 0 V((rl Inspection Type: {� <br /> SB180 Posted Yes No " Permit Posted Yes No r Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS .; <br /> � Gt » 1'YtiC aVt�l ✓1 <br /> h C,D ctll <br /> -b'✓ nwv aed& Inr <br /> it <br /> Irl S <br /> act <br /> _� <br /> a C?f<V P419 moi'' <br /> IMCWHIJr <br /> 179M "k.et- vanv <br /> a cf 7 M Qt&10"n�- ee <br /> pe Q <br /> J <br /> it AA W *e: hgA <br /> Item/Location LTemperature Item 1 Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: A Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title. , <br /> EH Specialist: — Phone: <br /> Time in: /► Time Out: 2 e Page,of <br /> (. l <br /> EHD 16-24 (2nd pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />