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SAN JOAQUIN COUP <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> -3420 Fax:(209) 464-0138 Web:www.s4gov.org <br /> Telephone: (209)468 /ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: �Y) Y-1 ,4".4c k d �/6dJ Date: <br /> Address: U City: Zip Code: <br /> Owner/Operator: fiey <br /> ki CW ,(VA�e-.A- Telephone: <br /> Program Element: Program Record: 11P/ IM Inspection Type: <br /> v /WT <br /> S8180 Posted Yes No Permit Post,-,' YesC/ No Re-inspection on or After: <br /> OBSERVAT19 AND CORRECTIVI=_ <br /> ---._........_-.._............----- <br /> 1 ............................. <br /> C� <br /> V� <br /> Akilk(q tA ;L C1W(6#- <br /> 6my M V "9(j,r. V',- C�l jkp9n4eaA C IjA21 <br /> V <br /> A ---- -------------------------- <br /> -KaV(a1WWV11- IVL4fA+ CU <br /> V" (kr 0(,(,tyf <br /> Item/Location Temperature Item I Location Temperature <br /> ...... .................-------- ............. <br /> 'I 0-vlAaui /1a(I <br /> C"14a& - pd2ti q- lr- - <br /> Food 7SW77&1�ftification Facility Hot Water Temperature Wa i"shing <br /> Name: 'Hand Sink: Chlorine: Heat: <br /> F ppm -F <br /> Exp.Date: V � -F Quat.Amm.: PPM Other: -F a��ing Sink: <br /> Received By/Title: <br /> EH Specialist: Phone: L& <br /> Time in: Time Out: Pae f t1l <br /> E HD 16-24 (2n'pg) 413/13 FOOD PROGRAM OIR CONTINUATION <br />