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PQutn, SAN JOAQUIN COUP. . f <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> _-= 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> c4.• ip Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.siAov.orQ/ehd <br /> tjii a <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: r u v e r 6A' r K <br /> Date: L/. 11 - <br /> nu <br /> Address: S s j �, ' 3j City. L) 4 I h rc 09 Zip Code: 9,5s,; <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: go n <br /> SB180 Posted Yes C No Permit Posted i- Yes I No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> d r ol ba V 12 d ' " i90 4rra 4 Vii ala46' on . <br /> I? <br /> f O U; dep e r f u vie 13 ; A dS1 S e r, C o ., C , .�► <br /> IoW. / <br /> 3 fOd: de s FnSPrS o✓ S cu n 0'� G Re v alrl-i <br /> G► ' nICA it i nS •} '. 0n rap Cr 'Y" �C <br /> LA . Id , N n i � 0 f^ u ,se . <br /> CA C MCI q do C iivo 4e VE V i e P c1 <br /> j IF <br /> S c M ryi U tiI ceA pr o.sa t yS <br /> O's r irl s h a ve r\-u u) 4'0 r. <br /> Item/Location Temperature Item t Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: r� Hand Sink: ,, of Chlorine: Ppm Heat: of <br /> Exp.Date: Warewashing Sink: of ouat. Amm.: Ppm other: of <br /> Received By/Title: <br /> EH Specialist:f ' Phone: <br /> Time in: ` �� Time Out: v Page 7of <br /> J <br /> EHD 16-24 (2nd pg) 4/9/12 FOOD PROGRAM OIR CONTINUATION <br />