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SAN JOAQUIN COUN <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> N: X <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • cq.. : �P Telephone:(209) 468-3420 Fax:(209)464-0138 Web:www.sigov.org/ehd <br /> ��POR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: I L � Y5. Date: ''',r ` <br /> � �rt�� 1.Z 4' C-(moi <br /> Address: -2A rq, yt� �,1NG VA tVIS42- City: � Zip Code: 61 550q <br /> Owner/Operator: %k <br /> & tS cj c' Telephone: _ <br /> Program Element: QProgram Record: Q5225 Inspection Type: �� <br /> S6180 Posted Yes1 No Permit Posted Yes o Re-Inspection on or After: <br /> OBSERVATIONS,AND CORRECTIVE ACTIONS <br /> I _/ 11... . ......._. rt s 4 roc f4 s Iva, S e o r»S ._.._. f <br /> We n-5 rps4rourn ) 0 (W5 1o, ltJ a Pr in �y,O� '6 IQ user. Cc recd"r/ <br /> 3 MO S. nKs hd Wa4Lr A ' 03 I'� /r/Gi '11 C, <br /> Wc, Icr X 20'( or above Corrrc •1 +a 4v <br /> 0 ¢ N c1 <br /> Item/Location Temperature Item/Location Temperature_ <br /> — ------- .-- -- ----- __ — - ----- -— - <br /> — _._ -.. . <br /> Food Safety Certification Facility Hot water Temperature warewashing - <br /> Name: Han Sir�k: F Chlorine: m Neat: F <br /> A t[ :� 11i � PP <br /> Exp.Date: g Sink: of Quat.Amm.: Ppm Other: of <br /> J <br /> Received By/Title: <br /> EH Specialist: t Phone: <br /> Time in: ---time,L s0 Q,(. Out: I_.2 q Page 7 <br /> EHD 16-24 (2^ pg) 4/3!13 FOOD PROGRAM OR CONTINUATION <br />