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SAN JOAQUIN COUN' <br /> y: X <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �;.. ;P. Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.slgov.orq/ehd <br /> <<FORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: W1 71 i i CA ib I tl l� j Date: b/ 0 <br /> Address: D-TT l.. C ( �MO S fi City: s�(,�/r'�VTO Zip Code: <br /> S <br /> � 1 � <br /> Owner/Operator: ejq u U Cun ` U/7 Telephone: <br /> Program Element: �� Program Record: G5 i , (� Inspection Type: <br /> SB180 Posted Yes V <br /> fo.f I Permit Posted Yes - No Re-Inspection on or After: w e v r <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> e��u - l; i _ t-u��K4, w >r 11 G�chQS • 0t\0 <br /> Wi h 10\ Illou YVM . }pct <br /> ;� arc tri a o'F YT12 .TtUuS CICS S C.,W) <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> -- -- -- --...-.........---..... ... — __ — ---...---.._._.__._.._..- -- ------ <br /> Name: Hand Sink: nF Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Quat. Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: �P _ ca .-': ,i1 if^r <br /> Time in: Time Out: (J� J`TTiv Page f �\ <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />