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SAN JOAQUIN COU* <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> . c... ;P• Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> 4CjFo'�ta <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ar> 5 p r i . r �'G n'IZ r Date: <br /> Address: / f I / L City: -T rc. c Zip Code: 953 7,6 <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: Q <br /> SB180 Posted ! Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> � � G <br /> he r✓1 i C a S 4-o re d hS' } -+ <br /> J to h. be t e w cin d 0 oc i/ <br /> r du ss. c r r& d 4 V o <br /> oCd rlCdt- is i A becK s 4arat e. <br /> S�Gr@ a II f 00e^ d a i C/t?un r, bre <br /> C C✓1 U i n rS (,tJ a h Sri t, i G A d c, b e C r re 4 <br /> G <br /> .4 0 d4 4 <br /> Item/location 1 Temperature Item!Location" Temperature <br /> —-- ----.._...--/Loca i -- —per <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: ' <br /> i <br /> EH Specialist: Phone: r 9/4 f/ <br /> Time in: Time Out: 4 J Page of <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />