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SAN JOAQUIN COUP <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax:(209) 464-0138 Web:www.slgov.org/ehd <br /> ��FORa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: i nip �X Date: <br /> Address: �'�l`Cl� t city: r�1vC*_ ton zip Code: 5Lp <br /> Owner/Operator: "(1i �j y t 1 Cd ! C I - D Glvo`.l Telephone: [�`�� r Z R <br /> Program Element: ,�A(j l Program Record: t.C() u 1(�0 l Inspection Type: C 1Gw cm w <br /> S8180 Posted Yes No Permit Posted Yes No l Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> CUM 101 O jr CUA,- oGt Gh vNCk 0 Gk SS G-� <br /> - u n o wcA t- CAA V\CA n-- <br /> - <br /> 0v-ed n, 5 deod c cc rOa S c n Sdi OWR S w�ir.� <br /> dry S`1 'eco <br /> (ANrLQA ( fie_ . -Cl h d-S G -t C cm�Ml ! Ca11 <br /> 00 P � V+Oa - CSR CNG UGI coGIa- KQ S.. <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: �F Chlorine: ppm Heat: F <br /> Exp.Date: Warewashing Sink: 'F Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: ,1 <br /> Time in: I` , Time Out:i 1 _ U Y� `i Page( of <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />