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SAN JOAQUIN COUN' <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • cq.. ;P• Telephone:(209) 468-3420 Fax: (209)464-0138 Web:www.si4ov.orq/ehd <br /> ti FORS <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: +7 13, `) c,i ( Cr� IJ `J 1 Date: <br /> Address: �-7 2 Q w, h, h A S� � City: S t I� � Zip Code: q G, <br /> Owner/Operator:/ 94 (4r M1'le rC e d Telephone: <br /> Program Element: / O Program Record: G00 Inspection Type: G i4l n'/ <br /> SB180 Posted Yes ❑ No Permit Posted Yes C No Re-Inspection on or After: i <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> GM r. elf '5 0 le') r_ r �� <br /> 0 b5erofed @ M g toege o;'I C h Celf r('' <br /> h /Ove Or p n /. i }DC' c� <br /> A (so ogs C, rved S C4 M M 0/C <br /> on hC t 10 Cr 4- <br /> a a <br /> Ie i Gn nCGnE : nf� � o <br /> G Ak nr �otACh ; h Soh, <br /> of cd, /is o e\ d r. cr 40 a ctr: r o <br /> d. <br /> Item/Location Temperature Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility'Hot Water Temperature Warewashing <br /> Name: Hand Sink: 'F Chlorine: ppm Heat: F <br /> Exp.Date: Warewashing Sink: 'F Quat.Amm.: ppm Other: 'F <br /> Received By/Title: <br /> EH Specialist: Phone: I-lLdi, <br /> Time in: Time Out: 2-c, a Page of <br /> EHD 16-24 (2nd pg) 4/9/12 FOOD PROGRAM OIR CONTINUATION <br />