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C <br /> t <br /> �k�WN <br /> SAN JOAQUIN COUN' <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> -3420 Fax:(209) 464-0138 Web:www.sig /ehd <br /> Telephone:(209) 468 ov.org <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: -'I­ 'f�/G r k/e Date: /2' / <br /> 1-i ti <br /> Address: e,V.,A -k 3City: Tf-_�( y Zip Code: qV-74 <br /> Owner/Operator: Telephone: n q- �X 3� <br /> Program Element: Program Record: Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-inspection on or After: <br /> OBSERVATIONS,AND CORRECTIVE ACTIONS <br /> CA 1*dloc ., <br /> h A . 3 he 1 V'r3 Of it of h <br /> b c M 0 ve ('c4 v f b cc4,-d 61 r,,of c/6,q n <br /> 1(jor. — ..Ccrrecl im WeIP14. <br /> C C4 r'64 �r.1 Or-, CC n oly A,5e r. Pe 11ACIVe TO d" <br /> ................................ ........... <br /> .......... ........... <br /> ........... <br /> AS b-c- e le k12 <br /> oic R e ,"i 113 WC Ate iSMC <br /> Item/Location f Temperature Item Location Temperature <br /> ......................................... —_'__--------- <br /> ........... ........... <br /> ............................ ....... ......... <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Hand Sink: 'F Chlorine: ppm Heat: 'F <br /> Exp.Date: Warewashing Sink: of lQuat.Amm.: PPM Other:_ of <br /> Received By/Title: <br /> --q 4r- <br /> EH Specialist: '00f_.r Phone: W r V161 <br /> Time in: Out: Page of <br /> EHD 16-24 (2�pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />