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�o..P4�.C' SAN JOAQUIN COUP'' <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax: (209) 464-0138 Web:www.s'gov.org/ehd <br /> (FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ( p U r-C'j CU P��� �c" r Date: C�j6- <br /> Address: c 13 Z K) <br /> o r' -1� 5 City: � Zip Code: <br /> Owner/Operator: Telephone: <br /> Program Element: Z� Program Record: C)(�ZSInspection Type: 2v <br /> SB180 Posted f,,Yes No Permit Posted xYes No Re-Inspection on or After: G�]eS21CS <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> /tea - 10S <br /> 5 <br /> &'_'j-e cL is s� I SMI =� /�'t 2iU►-r� <br /> Pry r �-6 d <br /> cf, t-,cr'(9�e2 0 <br /> Item/Location Temperature Item!Location Temperature <br /> Food Safety Certification Facility Hot water Temperature warewashing <br /> Name: Hand Sink: U� of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: Z� of Ouat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: A) Phone: 4-6, cP_ <br /> 34v' 57 <br /> Time in: Z r (.)5— Time Out: I ; Z Page_:)of� <br /> EHD 16-24 (21^pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />