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SAN JOAQUIN COL <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 7. 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax. <br /> (209)464-0138 Web:www.siqov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility- Date: fob <br /> City: Zip Code. <br /> Address: #16V z/ d1f ��lt_,f# <br /> C41 <br /> Owner/Operator: Vi'q _tAA a�,t;6L Telephone:-7)--7 -7 6 3 <br /> Program Element: Program Record: -:7L <br /> Inspection Type:tl�klldl�� <br /> SB180 Posted Yes No Permit Posted Yes ' 'No Re-inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> IWA 4A' f <br /> .17 JAI <br /> ................ <br /> �t�ql <br /> *L\ V� �x fr-,4 e <br /> LVGy �X_& L) <br /> 11�1 JUV A (�Nt) -S PO m/1- <br /> 13 <br /> j Temperature Location en <br /> rature <br /> f <br /> iiii i vta�, (0 <br /> ti <br /> Ai <br /> o" <br /> 1,-\,P6Vyj171,, 14kV/L Id_MAOv �rs)c <br /> oq 4 It <br /> L r <br /> .04Alf 1-- <br /> "%o`tf n Facility Hot Water Temperature <br /> Name: Hand Sink: � �F Chlorine: Heat: of <br /> 7 1 PPM <br /> Exp.Date: Warewashing Sink: 7 of Quat.Amm.: ppm jOther: of <br /> Received By/Title: 7C-7 <br /> EH Specialist: Phone: <br /> I K <br /> --- , ­.W__ <br /> ... _ - <br /> Time in: �0 Time Out: 1)7-� 3-7- Pagy of <br /> EHD16-24 (2nd pg) 4/3'13 FOOD PROGRAM OR DATION <br />