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SAN JOAQUIN COLIN <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 /> �iFORI� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: J 86 r L u n e Date: �_ <br /> Address: U ` v e City: -T-rU C Zip Code: 9 S 3 >7 6 <br /> Owner/Operator: _ Telephone: <br /> mrn. c h�� I �• 11, � a (,�J:fl:am) $31-g94Y <br /> Program Element: PRd: / Inspection Type: <br /> ((vG2 Program Record: S G �� CC ASu I fu 1, <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> G 11 S ,it l\ I <br /> CIC SC q C4 n Ci q _i/ �u z i Ld S i n s i rS _ c. r r�� t 4 <br /> dD r i a,- a A n <br /> G 1, n PY i Cc, fm 0 C h;rXe adv;r)e r . <br /> lot <br /> Prod i ; rich IL -door AK <br /> f • CCfm CI CA; n (Orr-Ed ;n '.Z we, je S. <br /> cfo i Hca lleo� lD/o✓ A <br /> 3n- COM Irni' o t / �� W: IK r r i KS <br /> ,`CMJ G 000 U n CG 1 �o+ W PC o/ 4-0 <br /> 0101 ,'r,,dh C lo nnobieGn -C4 bSOr A7 Art SSc4 r C. Ce , <br /> Corted In 2 We,e K c. <br /> 6 k F,n e r"As 4hrcu y d r 19 r0 v,- Ce <br /> 40 re Ve A .I Cr n 4 Ccrrp -+ -Ic o s. <br /> pro V. de cl /r Ce S; j K Ih he+ And Cold 4,?r G oe <br /> cl back �l ,.�f' / feeVlfnai on Ole v,te. CoYe- <br /> re�a 2 ex <br /> tly Pro V; A <br /> Re,54ra-A CO +an K -I 2 WeQKs. <br /> 64 C K er yi, I -1a 7'1'1 a�-oh 201 N a IJ 40 P e 4 <br /> Pt IL4 P GV 4C f- Perm <br /> Ao NQ1 US.n , . >hu' hri . <br /> 11 item/Locati Temperature Item/Location Temperature <br /> 1- <br /> door <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: Al' r;� of Chlorine: ppm Heat: °F <br /> Exp.Date: Wa washing Sink: of Qua .Amm.: ppm Other: OF <br /> /1C <br /> Received By/Title: d <br /> EH Specialist: Phone: ,/6 ��60 <br /> Time in: Time Out: Page/of 1 <br /> N.- 12: 1 <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />