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y0SAN JOAQUIN COU Y <br /> OG <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> LlFOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: P d"-k CA- Date: I H6— ILI <br /> Address: A5 Iz C"not 8-C, City: S im CA c.-to,, Zip Code: <br /> Owner/Operator: vG Telephone: 5 It <br /> Program Element: 9 Program Record: PIS NQS Inspection Type: fi <br /> SB180 Posted Yes :ANo Permit Posted )(—Yes No d Re-inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> ........................................................... <br /> _S 0 r o (:: Cc c_co_ Y,-e— ey"n 0 ra <br /> ................... ................... ...............1-........ .............. ......- <br /> (D <br /> nn <br /> 4 615 1 C 4-K-ov--4 L_'5. V'I'S c---b Lt +r' CA.43+0 tk,-0_,-y <br /> ............... —------ .................. ------------ <br /> ................... <br /> ——--—------------- ........ <br /> i <br /> Item/Location i Temperature Item I Location Temperature <br /> ................------- <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: F Chlorine.. PPM]Heat: 'F <br /> Exp.Date: Warewashing Sink: 'F Quat.Amm.: PPM 11 Other: i 'F <br /> Received By I Title: i /4e— <br /> EH Specialist: Phone: <br /> 01-53 <br /> Time in: Time Page rf I <br /> C� <br /> E HD 16-24 (2r"pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />