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0P°u`"'C, SAN JOAQUIN COUN <br /> Z, ENVIRONMENTAL HEALTH DEPARTMENT <br /> Y. 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> LI FORK <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: J �c.2 C V -i Date: <br /> Address: �p 5-� �1 e J ef\ L City:;(-C,\C Zip Code: of <br /> Owner/Operator: \0 Wip-C,e C� Telephone: <br /> Program Element: b Z� Program Record: t 0. 2>114a Inspection Type: �R <br /> SB180 Posted Qejs No Permes it Posted YNo D Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Item/Location Temperature Item/Location Temperature <br /> 3c;t F <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: f S f1 J G�C J_-j S fy'\ Hand Sink: I03 o f Chlorine: ppm Heat: '%-+0 o f <br /> Exp.Date: ,2_ _ 1 ra Wa washing Sink: ' of Ouat.Amm.: ppm Other: of <br /> Received By/Title: v <br /> EH Specialist: ,'\ Phone: <br /> Time in: V 2' Zo a <br /> Time Out: i Pagetf <br /> EHD 16-24 (211pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />