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SAN JOAQUIN COU <br /> gyp,.......;•.0 <br /> 2� 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 /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 1 1 U n +7_'�/1 Kl SP 1, Z A Date: <br /> Address: y 3 3 Q O rea a� City: 1_ n Zip Code: ,� '2 <br /> Owner/Operator: I y r 12 :51 n +� ��+� Telephone: ,S2_4 t / <br /> Program Element: Z/ Program Record: ��! d J Inspection Type: <br /> B180 Posted Yes ❑ Rermit Posted Yes ❑1 Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> � _ <br /> of vJ o pit <br /> Q 2� i i cl r <br /> k <br /> 14 41A 4-7;p S <br /> ri �_ <br /> 'S o Y� oAj0 <br /> r a4 <br /> o J - <br /> Of <br /> Q y' <br /> S br <br /> ONL <br /> f `60 rr? c <br /> I5; mad 4Lzake'r -e — <br /> ire) C& <br /> ?rev - t ° <br /> Food Safety Certifica€ion it Facility Hot Water Temperature I Warewashing <br /> Name: Hand Sink: o Chlorine: Heat: o <br /> i J 11d k uwck, / (,-,b ppm <br /> Exp.Date: ? / arewashing Sink: of Q! Amm.: Z_60 ppm ther: of <br /> Received By/Title: �t <br /> EH Specialist: , � GPhone: �- <br /> t� <br /> Time in: 1 11 0 <br /> Time Out: L Page of <br /> EHD 1624(2-pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />