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SAN JOAQUIN COUNT` <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 41: :< <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • .. ;P• Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.slgov.orq/ehd <br /> 4c,FORa <br /> FOOD PROGRAM OFFICIAL (INSPECTION REPORT <br /> Name of Facility: p Y {O %- (aY -P—. Date: ,210_1 Ll <br /> Address: n 1,�� �.� City: 5}O�+Dfl Zip Code: 01i5�0 ILI <br /> Owner/Operator: I A �1 Telephone: 'P L1 `8,�G 2 <br /> Program Element: 1 moo Program Record: C000 300 139 Inspection Type: COrn <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> (',o c rC roa-Gh 4 5 Lh -moo d ip oXtS -I-n 4:xc Se.Y v-t +o T.c b U c <br /> L-r1 bck-C4C, o-fr -;-C-1 U <br /> Lrac:�rl+ PLA- �- Yu .V_ r <br /> he c.< L4' 40.9 . r' <br /> pC. .M r? 4enin. <br /> nil a <br /> 1( Y-c a n CA <br /> V I S(+S m \!-O LLt n r c k_. <br /> ff n +� 0 d <br /> * Ser A4i 0 n_-s Fa--eA LIQ C 5 -e_r11J O - - <br /> _e V'1 &a-yl cA_ r p 11 k_t_ <br /> Item/Location I Temperature Item I Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> --- ---_...._..._................_..--_._------ .— --- -----..._..__....... <br /> Name: Hand Sink: of Chlorine: ppm Heat: "F <br /> Exp.Date: arewashing Sink: `F Quat.Amm.: ppm Other: eF <br /> Received By/Title: <br /> EH Specialist: a Phone: q -� <br /> Time in: •I Time Out: ! CX Pager of ' <br /> EHD 16-24 (2n1 pg) 413113 FOOD PROGRAM OIR CONTINUATION <br />