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PSAN .10AQUIN COI. Y <br /> �O. .CGuz6' <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.slaov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: r v + r U 1 Date: 5-16 -19 <br /> Address: 9 U-) <br /> l r-e m or r- City: Zip Code: 9 52L3 <br /> Owner/Operator: 1 LICt 0 rl5 (00 ­6 0 <br /> 50 Q Telephone: &(1 _L 9 10 <br /> Program Element: (0 Ct® Program Record: P R 05 2-6 Er C4 Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes 1� No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> _ r_xr 3r 10 Ci:z> rw k Lin L) _-,� ti - �» <br /> 1 <br /> / r /YL ' <br /> O fi�n <br /> Item/Location Temperature Item/Location Temperature <br /> t�� clay h7ol:<tc r <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: �U4E.Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm other: of <br /> Received By/Title: <br /> EH Specialist: Phone: Ols3 <br /> Time in: 10-o-'15 Time Out: (' Page( It- <br /> of <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />