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0' WN.. SAN JOAQUIN COU t <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.slgov.org/ehd <br /> �/PORN <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 51 &4-- fyl _} Date: a-1 ;Z-1 14 <br /> Address: oZ a 3 (a rnrl C:a l'lA I \U d city: �+ o �n Zip Code: 5;;L0 <br /> Owner/Operator: l j�,,rn (YI-e N ro t< Telephone: 8 12 LI_0a 6 <br /> Program Element: 140 is Program Record: D P_Q52(o8 3b Inspection Type: <br /> SB180 Posted IXYes , No Permit Posted) Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> W L=1-h 501F* ri — l t' Vit or Gi rt! <br /> rv2 " Y- Y &"7 ry.c_ 1.c <br /> c:5a i ro c.cwo P 1L <br /> d iov r s -e e. no Ciel Vi <br /> e ri O' YN.o F to m r,5 G <br /> Q�rS r ct Ic _e,4-P-c r YMA Ss i Itjo <br /> V A L e L-aL <br /> b - <br /> Item/Location Temperature Item/Location Temperature <br /> W CALA Q 11 W1 A,Le,o b- _ <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: /a ! 'FLuat.A <br /> ai � ppm Heat: 'F <br /> Exp.Date: ar asking Sink: ofm.: ppm Other: 'F <br /> Received By/Title: <br /> EH Specialist: vV>��, L Phone: <br /> Time in: I Time Out: t ',( Page of <br /> EHD 16-24 (2^d pg) 4/3/13 1 FOOD PROGRAM OIR CONTINUATION <br />