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SAN JOAQUIN COUP . <br /> 6.1 <br /> y-� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sogov.org/ehd <br /> 9C <br /> /FORM <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: S n� II Date: <br /> Address: 1 i�� h City: roc Zip Code: 9$ $ 76 <br /> Owner/Operator: Telephone: 3-36- �17O� <br /> Program Element: Program Record: Inspection Type: PIC IIA Cb <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> Lhrrn:coIS 5+-ored C1do+'t ercc%+c s _ Remeve <br /> hcm ; Cats <br /> rloor .s;A1( G' SCC{ A is f^SP!- GS b'.. /W-ue G ieon _ <br /> 10 a <br /> Cc ✓; AV 4;ie Wu -in A r. k arca Cre )ep n /G(kin <br /> .r o1 0 in 2 Lj e La IC5 1CP a /a an <br /> 4 a n ICs Li .-.S f ru ite ClR 03 Ira i d <br /> $ cr bc. aile tolfw in be., Ck( <br /> sc� <br /> f a G n d m '-5 p S tr-vC,m . � I ; rr A. <br /> W. { h r\ Oki Gb 5 C r b 0 n a IC) b �C� <br /> e t- 115. <br /> a eo, i r <br /> inwee 16 <br /> Pole AGbie CLOCK LA)0vY)pn'S orr /ac Ked rte, <br /> Item/Location Temperature Item/Location Temperature <br /> ---- ------- ............. - -— -- -- — — <br /> tl <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: / Hand Sink: 1 of Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: ( of Quat.Amm.: ppm Other: of <br /> Received By/Titl <br /> EH Specialist: Phone: <br /> Time in: G Time Out: V�OI Z Z Page of.;, <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />