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�Qu�k SAN .JOAQUIN COUI ' <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax.(209) 464-0138 Web:www.s4gov.org/ehd <br /> ��PORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 5 D U-/ T�)v d Date: <br /> Address: City: �� � Zip Code: �Q3 <br /> 1—ra�mvr,,� <br /> OwnerfOperator: Telephone: <br /> Program Element: / 2 Program Record: y 7 Inspection Type: !w <br /> SB180 Posted 71yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND,CORRECTIVE ACTIONS, <br /> _ <br /> )'t r <br /> (� to Y► rL <br /> - rte-1- av c �t ( -�Z.Qro <br /> ..ems-=--- ,Lev e c� k c��.�- -- ►�-, --- <br /> i�j L -� W 1-L al•,- c1 __g V-e _ Y--es <br /> ash s r i e7 o L <br /> fza h rl n ,-�`. o Z'-P- <br /> r rt-a-L-eel _ <br /> mod na, .e �r-t-i ��-1-c. aU a� co-J2 fie.. ,�- o w -e r- <br /> Item/Location l;Temperature Item/Location Temperature <br /> CIM Y- <br /> Lflo - <br /> ture Warewa— - _ -- — <br /> q ac Notrt4iater,Tem rashin <br /> ` aotl; ryertificUon _ _9 <br /> Name: . Hand Sink: !� of ori.- n�;, U� ppm Heat 'F <br /> Exp.Date: �;. arewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By!Title: <br /> EH Specialist: Phone: <br /> ------- <br /> Time in: Time Out: D Page 11" 66 �f <br /> EHD 16-24 (20°pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />