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Pte"'" <br /> o.� SAN .�OAQUIN COUN i Y <br /> � .eOG <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • cq.. -.a�P• Telephone: (209)468-3420 Fax: (209)464-0138 Web:wwW.s4gov.org/ehd <br /> �/FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: OavLr e - Date: 10 wn- <br /> ddress: _j"5' W /4*yKW,` [,l-L City: Zip Code: <br /> Owner/Operator: ✓ !k-L L Telephone: <br /> Program Element: I Program Record: S � Inspection Type:Q 40 <br /> F1 k7 AW <br /> SB180 Posted ❑Yes[❑ No Permit Posted ❑Yes [] No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 4- Yn� <br /> t <br /> .e a✓ � �' — <br /> �( f rc Ah <br /> 10 CW <br /> s _ <br /> 11 JUVIWCU 40 ht a k7 d �- <br /> .e w <br /> f <br /> R�v�-e-aL eco V ntic <br /> c ' <br /> Item/Location Temperature Item/Location Temperature Item I Location Temperature <br /> Food Safety Certification - Facility Hot Water Temperature - Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: <br /> Time in: j f Time Out: Page ofO <br /> �` <br /> EHD 16-24 (2nd pg) 4/9/12 FOOD PROGRAM OIR CONTINUATION <br />