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SAN JOAQUIN COUiv . Y <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 600 East Main Street, Stockton, CA 95202-3029 <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: A 777< Date: / <br /> Address: K City: Zip Code: <br /> Owner/Operator: / A. vz�k_ tet' Telephone: :3! s <br /> Program Element: Program Record: Inspection Type: J� <br /> S6180 Posted C Yes r 'No Permit Posted es ❑ No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> pi ( vl < <br /> r7k I/ <br /> P h N' l CAftxw— 'dazia mi&wltiko <br /> ' avv� CUP[ �- S�DW r�lcC <br /> 4990yz 4W4 ayvx Q—a, k- - /A- c ! <br /> ou r Alm <br /> -, /if �i l / vet <br /> ' �- ., � I/�'��L-f— 6 1' ��I�G,C {2� ;'.-� � - r' �r•'�-�t' �r� vie <br /> Ite o Temperature, Item/Locati Temperature Item/L ation Temperature <br /> o f Certificatl n Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: _If of Chlorine: ppm Heat: of <br /> Exp.Date: arewashing Sink: { of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: C` Ph d: <br /> Time in: V Time Out: 5 .�� Page?f <br /> 1 <br /> EHD 16-24 (2nd pg) 1/18/12 FOOD PROGRAM OIR CONTINUATION <br />