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SAN JOAQUIN COU <br /> X ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> cq. a�P Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sjgov.org/ehd <br /> <<FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: , w I Date: _r? — f <br /> Address: Z Rn 2i i<_ ^ - , City: L__�+r� Zip Code: <br /> Owner/Operator: A u� Z--t_LL Tv Telephone: i`/ l CJ <br /> R I/ <br /> Program Element- Program Record: PO 11DO 44'X Inspection Type: w_ (� ' t0 <br /> SB180 Posted )q Yes ❑ Rermit Posted Yes ❑ 1 Re-Inspection on or After: 02 <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> J <br /> r-)8 ` 1 i.w <br /> Pro v-i -�- ICA �n <br /> Q 1 bi SW L450 n DO r+ f'Q 4Ucx_+ tAb <br /> Y4ICaV)'U r <br /> n 110+ hO+ <br /> 1 -12-4T. 4 <br /> co L(.� v 10-t ha 6-f- D 4. <br /> 5 Y- >-e r f°� r a I <br /> Pro )3-P- -bkevry> rykt4e Y + a 0 OL; + al <br /> >r LLQj <br /> a4_dcL Y <br /> L � <br /> + — V41 a-4 <br /> MCS rn,o-K.P r CL.U-f-)?C-fes r D a- e ha-S YYL6 C_c1 . C wi n b!-j <br /> 1o� <br /> @6 6 " <br /> l w� <br /> f,. ItemtLocation Temperature : Item/Location Temperature <br /> ' _ r <br /> Ig tr <br /> Food Safety Cel ication Facility plot Wafer Temperaatture Wppma�shmg ' <br /> Name: , Hand SChlorine: Heat <br /> ink: orine: . of <br /> Exp Date: _ arewashing Sink: <br /> OF Quat. AMM.: ppin 'Other: of <br /> Received By/Title: '� 9 <br /> EH Specialist: j� Phone: !J 3_ 1700 '17 <br /> Timein: ' Time Out: , Page lof / <br /> EHD 16-24 (2n°pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />