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SAN JOAQUIN COU <br /> �oP .co ARTMENT ENVIRONMENTAL HEALTH D <br /> Ur. :< <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> L�FOR� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: �� 1 �l L� M�1 Date: i^y <br /> Address: ;u(} S' r }��,17�d0 �� City: S#C*-1 zTl Zip Code: 15 2OU <br /> Owner/Operator: 1A W-In (Apo Telephone: 451 <br /> Program Element: 1 u 1 c; Program Record: 1j O 1 22 C Inspection Type: C\101 <br /> SB180 Posted VYes No Permit Posted Yes YNo Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> ,&L-Oa W&10C . M&ft 01 a .eP s '9f O)S- k '(A SIC{ <br /> bWrved a « 0CK +s <br /> vrGW'1'wfh cOal roe r a c h t&g ci.,i),ld- implemn <br /> �s-F �o fiYa f <br /> - <br /> t rr + est ccmft "CO <br /> U SCoup LAMed Gn Cf G 160UF21r, n5`c1.2 a <br /> cit <br /> 1weIs a\-6 wcsb 90t'-m - Yovidy, tzdaN , <br /> to �0 SV U( vGl t)cu <br /> to C2)d CT <br /> ^Y '�AA 4 D`lr L1=11(�C Q CA1 . <br /> Item/Location TemMature ftem I Location Temperature <br /> VYYA1k 1 r► COG�i( ' �_ <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> — .._.. - -._.._ ------ ---- ---- - _--- - <br /> ........._..... <br /> _ <br /> Name: Hand Sink: "F Chlorine: ppm Heat: 'F <br /> Exp.Date: Warewashing Sink: 'F Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: 1, 00 Time Out: ; 4-0 Page!Df <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />