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Op'gU[,k„'C SAN JOAQUIN COL 'Y <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> N: X <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sggov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: !?Ir��_� <br /> Address: f ' [, -� /� ,� City: `J�c 1 z 7 Zip Code: 9520 <br /> Owner/Operator: �N Telephone: _ 4 <br /> Program Element: ( �2t[ Program Record: rJ 2-70;7Inspection Type: (20v <br /> SB180 Posted Yes--�,No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> I K-e_4 t-CSL,- 1-yo✓ },n r 1. b� © �`.fn <br /> �a ns + 5 a LA 6-e- 0-t o rn o r 6je-c no <br /> 6D Pyl c o v- rem{ •o d, 64 n vai c -fcpo d <br /> 6yL&U LOA= ray <A - <br /> 6 Q'I I I I �1 ,�g 6.� r)-s <br /> -I�i►� >7<1k 1 S h4- <br /> YY1-� <br /> �- o r✓r i -c n 4- so <br /> Lfoc <br /> n a- o Y c%s +0 <br /> h '0 (8ID VW-Ik ?05+- '0 <br /> f u 5+0me, rs' <br /> s �.e� Y vK -Id La r�BC b cls. L�,h-cls "u 1-:a <br /> V1 of nm 'p f!� S+y rye k �me d '-n ro d.L'c.-f- .C'-j:, C.'G CL-e- <br /> "-d- 1.1MIrtdAfn+s <br /> D D <br /> Item/Location Temperature It /Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Ware washing <br /> Name: Hand Sink: o f C L rW�yq.4_ IC)O ppm Heat: o f <br /> Exp. Date: WarewhirSink: of Quat.Amm.: ppm Other: of <br /> r <br /> Received By/Title: <br /> EH Specialist: Phone: J —f <br /> Time in: I V1q0 Time Out: ;0 �- J Page of 3 <br /> EHD 16-24 (2"d pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />