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,oP .�oG SAN JOAQUIN COUP <br /> ENVIRONMENTAL HEALTH DEQ-ARTMENT <br /> _ 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd <br /> Phil", <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 1r� s Orr. Date: +j2-+/ I� <br /> Address: Z(ri-1" S o CjTznc)o Si' City: Sto"-f6m Zip Code: G°nA� <br /> Owner/Operator: rlAn (qrG Telephone: 6-2-cl_ r-004 <br /> Program Element: 1(V 00 Program Record: C0oo3(06G 1 Inspection Type: CoMplCkk',rl+- <br /> SB180 Posted Yes i No Permit Posted I Yes E No Re-Inspection on or After: C-C Dh <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> MjU;h+ Stc4e& *Hr*Hce Vcjmaw - - <br /> �r oc.(. r �- rI . z+ cues b 2 +Ieeno <br /> b S ybo 1hre4rw ck 'homemude bcmbtt) St� . <br /> -%e +i rS+ SbOve halc)i 'OerS Is cc4nQ4e1 rr rd <br /> The I i0+5 GbcArR, tele e Ui�O .i�z& Wave 4yt+--IP�t' <br /> In �_ blinds are . <br /> _ - 1-'h e r W e is 11 guine <br /> Ore GVY01 M40 Ord ncxs b u S Q Faq 01Cyr. <br /> _- some Vgc +icmc_5 Ond Mn v s Q �n 110e v lt;!� Of <br /> -tire ir. meted and U . <br /> feu olis -0 Wirain Clb utijh1 firms strxr✓ Is rexalv <br /> AP CO wa-V-i Off)"- YWAM call L *%, P W- <br /> �l -the Eli iS C, reins an. <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: LHeat: °F <br /> Exp. Date: arewashing Sink: `F Ouat.Amm.: Other: F <br /> Received By/Title: <br /> EH Specialist: Phone: + �_ (Orj —34 A G <br /> Time in: Time Out: 10'.60 Page kof16 <br /> 1 <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />