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SAN JOAQUIN COL Y <br /> � •.OG <br /> Q` ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd <br /> ��FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: <br /> r l l- l �2 -/--:5 <br /> Address: s U L City: Zip Code: g 5.;,L_o 9 <br /> Owner/Operator: /Q/ a erci! do &ZR,, Telephone: 9 <br /> Program Element: / Program Record: pIZ 0 <br /> 50-1 <br /> .109 Inspection Type: <br /> SB180 Poste4 z Permit Posted Xyes No Re-inspection on or After: <br /> !� C� OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Yyly.->4 U i o C.A +ian s Lu inx 4k n 10 -1 (-1 3 u1.en..e, C,o r , <br /> _all a6`1 C W-Q. Y"O tl"1 -0 cl a <br /> r ru-e_ a ' <br /> Yo v-t <br /> U- r e <br /> iz c� i L c r5 <br /> V-2. LJ L <br /> rices_ CLL4f ✓ <br /> a <br /> F60 o Y1La o n ►-d o u—� -o C1 a re <br /> �' S e( Ce� r <br /> -Fo o,4 5 _ t-rt t o cLL I. - P-7 ©t&r <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Ch.l rin ppm Heat: of <br /> , 4 �� - <br /> Exp.Date: ��� Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: / Phone: <br /> Time in: /J . Time Out: f (� Pagel of <br /> EHD 16-24 (2`n pg) 4/3/13 1 FOOD PROGRAM OIR CONTINUATION <br />