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SAN JOAQUIN COU, <br /> X ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www,sigov.org/ehd <br /> 4<<FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: « Llh ' +i. (3 O Date: 3--31-16 <br /> Address: (0-2-00 Pa a fi L AV-.e- City. 5-0 ocftel Zip Code: 9 6-LO 7 <br /> Owner/Operator: Po-t,i ( ot aQ if Telephone: 95')_ 17 <br /> Program Element.- `(023 rogram Record: p O I b b..l `� Inspection Type: Roves <br /> 6180 Posted *Yes ❑ Rermit Posted f Yes ❑I Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> (Y) 15S C aA C-C,z I t-1�-c C� �� c rri I� V_ - <br /> 1&_ce. <br /> W-IC GS VlatC to re 4-t . .rns4-.Ll.t <br /> r0 -a-r .+Qv' 5 e c,'f + <br /> OLLKALnrf Z.� v1-:5 Ct? r,, r•.e 55 o r — rtis, <br /> b m am-44i rI n LI N i c4e.- <br /> - r d a-c.-h to©r n de r <br /> act w a Z6 on sc, '.W 40-e-K <br /> u cit r r i 61 c.14, a 6e t <br /> Item" cction Temperature Item I Location Temperature <br /> ....._ ._ a — <br /> a doo r'Tira�ls e n (AITF 15 <br /> 1 <br /> 600Y` CW(X 31''� Gyve 1�� rS hyo�_ h�C dQ Y l6 l <br /> l� <br /> 1 3 VAI` <br /> - <br /> Food Safety certification <br /> Name: T A v iA 'j . j 'I a Hand Sink: �L o f Chlorine: ppm Heat: F <br /> 1 _ V� J <br /> Exp. Date: _IQ are ashing Sink: of Quat.Amm.: � ppm Other: of <br /> UU �►� <br /> Received By/Title: <br /> _ n <br /> EH Specialist: Phone: <br /> Time in: ,2-0 Time Out: l l Page�of 2 <br /> EHD 16-24 (2o°pg) 4/3113 ` FOOD PROGRAM OIR CONTINUATION <br />