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�q.P4 !NQ.gAG . SAN JOAQUIN CATY <br /> z ? ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> •.c4.. ;< Telephone:(209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: UdPraa,4lz�> FkQ Date: <br /> 94 <br /> Address: 1 IA t„l(I` -a City: !' ` UL Vr,J Zip Code: nF.�— <br /> Owner/Operator: ��� f O Telephone: 01-63!_XJ �- <br /> Program Element: t L)2- Program Record: w�- �- 'Z_ Inspection Type: l V P <br /> SBI80 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> N PNS � 5 C c.1�5U 1rL+ G� <br /> G4 Q A RU SG f e -h (ptW i n G2-0 <br /> z rt1�t�fe 1P�t"U�l <br /> i eCiro Injccm <br /> 3 Al z Ojokc-no ecn bmelk of <br /> U t <br /> DS a 2 Cup Sm� w -Nk-\ cY.l <br /> vx-k n G Kin W ro (n as <br /> \roi f N1t?cAi uN , <br /> mqvM G btYl� wi1� 1R Qm- <br /> G Gn 'tn `-%Cv Gi- ConTNQC�i(,1-1 . -- <br /> Item/Location _ _: _ tire .Item/Location STemperature <br /> — <br /> - <br /> C <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat. of <br /> Exp.Date: arewashing Sink: 2� aF Ouat.Amm.: ppm iOther. .F <br /> [EH <br /> eceived By/Title: r Awn <br /> Specialist: Phone: <br /> ime in: Time Out: l ," 'L TJ Page r f <br /> EHD 16.24 (2^ pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />