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o°411" C/7 lT <br /> rr SAN JOAQUIN COUP /f <br /> � .�.eoG <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.orci/ehd <br /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: `- `i,J 4-y( ('epr7 l� ,� Date: <br /> Address: - r{G City: Zip Code: <br /> Owner/Operator: Y , A "/7, C Telephone: <br /> Program Element: Program Record: �J -� Inspection Type: 11Gw —U <br /> SB 180 Posted Yes o Permit Posted Yes No / Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> TP (1 i.1 6 "2&' - l- i'/ G tr <br /> MMI It 0- 676-1 Z <br /> �/ <br /> 4 <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> ----- —— -- -- - --- -. _. .__�...--------- _ <br /> ._._ _._—... -----—..._ ..... <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp. Date: Warewash% Sink: of Quat.Amm.: Ppm Other: aF <br /> Received By/Title: +r <br /> EH Specialist: Phone: _ �T- <br /> Time in: f i Time Out: + Page/of <br /> EHD 16-24 (2^'pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />