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SAN JOAQUIN COU, f <br /> ?a 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 y.{ � Date: <br /> Address: qD L/ �r-e /.v7Q LT T City: 10C44c-.�o Aq Zip Code: 9 5A-03 <br /> Owner/Operator: V A'Tl L�O"S Telephone: <br /> v-M�o <br /> Program Element: b�� Program Record: © g a Inspection Type: K fi'�-e— <br /> SB180 Posted"P-Yes No Permit Posted'7-Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 0-a r-4 a no Lki u u55i-� <br /> Lo co -t t>Lt-J 6p®+, A ' <br /> Item/location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: Jav of Chlorine: PPM Heat: of <br /> Exp.Date: Warewashing Sink: of Ouat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Q`M Phone: C353— 8 ,� <br /> v <br /> Time in: tv;Yr Time Out: D; Page,,P-f <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />