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oa"'" SAN JOAQUIN COUP <br /> � c°a <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> oq.. a�P Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sugov.org/ehd <br /> �/FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: ��`�\1�wl X Zu Date: �� L�� •� <br /> Address: ?)CA10 <br /> \�jj , . .1 blip- y_�� City: TV, <br /> V,".0 Zip Code: 6(S <br /> Owner/Operator: �Q'�F�M 6`� S AL L Telephone: <br /> Program Element: ^ref ✓°q Program Record: oS 3� Inspection Type: <br /> v <br /> SB180 Posted s No Permit Posted es No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> � on�1, V1t�� r�•k 2=\\S"� . ul���� u,,,�wa-- - ,� laa-toy°�', - <br /> 2 <br /> \1)4?jL.)0uy\dCann n Ska1-a� rri. J1naJea- <br /> s�d,�- _ d��s'�¢.�A-der a�che�l��1� �1 n�i�rr�►�•. <br /> ,tom\ bvvk -h <br /> ��� .A•� Jry v,,�� \ QS rv►c7Je Q � -}��n e�o�1 �l�iit� <br /> l6 �U lQlAe\ <br /> -j tiwac4� <br /> d . Wtva , -t%,kcyj <br /> Item/Location Tre Item/Location Temperature <br /> emperatu <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: k( �C • 6I o_ Hand Sink: �U `V-) �F Chlorine: ppm Heat: of <br /> Exp.Date: , 1� So Y� arewashing Sink: �, it o f Oxat.Amm ` Jppm Other: 'F <br /> Received By/Title: <br /> EH Specialist: 1 Phone: <br /> Time in: a Time Out: Page f <br /> EHD 16-24 (2°a pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />