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SAN JOAQUIN COUNTY <br /> z� ENVIRONMENTAL HEALTH DEPARTMENT <br /> __ Telephone: (209)4681868 East Hazelton Avenue, Stockton, CA 95205-6232w <br /> �q... �;;P -3420 Fax: (209)464-0138 Web:ww.sjgov.org/ehd <br /> �lFOf� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: q HrN r �� h Date: - 4-12 <br /> ddress: C S '' !► S 103 City: r G t Zip Code: G'� L <br /> Owner/Operator: R I l -, m e r\0 J Telephone: oC /' 0 7 _ C�U Q <br /> Program Element: Ito I Program Record: S � �`60 24 Inspection Type: 17 <br /> C C h I i <br /> SB180 Posted 17 Yes 0 No Permit Posted F.Yes ❑ No Re-inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> i-0 v. A oral C_Pr 4• r ) c t �1 <br /> G;n G aC d n i �� hPn rn i <br /> Q <br /> z� o <br /> Conti: ; onu�I C) k' VJa �nr <br /> rt'17� (+ t. i^:, Cr rC�! i !��� 0 /�tj-d '� .jigr h,�G fPY U): I <br /> Item/Location Temperature Item!Location Temperature Item/Location" _ - Temperature <br /> a JoIL r 33 <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: ° Chlorine: ppm Heat: <br /> Exp.Dat Warewashing Sink: °F Quat.Amm.: ppm Other: °F <br /> Wle <br /> Received By/Titl <br /> EH Specialist: Phone: <br /> Time in: 12: U Time Out: }.OS t7 v Page of <br /> 1 I ! <br /> EHD 16-24 (2otl pg) 419112 FOOD PROGRAM OIR CONTINUATION <br />