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°w" SAN .1OAQUIN COUP _ Y <br /> .�o <br /> a` ENVIRONMENTAL HEALTH DEPARTMENT <br /> W :[ <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.segov.org/ehd <br /> L�FOft <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 44� ld-t�J4 r Date: r <br /> Address: -7. kt+ 451: City: C Zip Code: <br /> Owner/Operator: CA-4 k1L J Telephone: ll !! <br /> Program Element: Program Record: b5 X) Inspection Type: <br /> SB180 Posted Yes No Permit Posted)(Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> b . Pr V -5SG '�2 a U P 5 c It t,{c <br /> 6 TO t,c, r C i d Pro v-f' �' <br /> < � <br /> Re s4roo m 14.e4c_5 A w Cf S h 5 Ic n ,e a ro vi d_e- <br /> V, C.t1 Pr;k-7-,q b 00 r d ce <br /> Vej, b r O>h V-a-el C O o a r c� <br /> ✓i -1;6t CZ.e ✓f'►-o V-C .'C r-ki <br /> Item/Location Temperature Item/Location Temperature <br /> 5 d � <br /> Y l OF <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: i a co n Hand Sink: /3,! 'F Chlorine: ppm Heat: 'F <br /> Exp.Date: [J ,I _Y p arewaahing Sink: l3 < of Quat.Amm.: � ppm Other: of <br /> -I G D �O r� J <br /> Received By/Title: 1 <br /> EH Specialist:2nr\ &A�_ k Phone: ,fig <br /> Time in: /0 <br /> W Time Out: Page of <br /> EHD 16-24 (21 pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />