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SAN JOAQUIN COUNT. <br />Z� ENVIRONMENTAL HEALTH DEPARTMENT <br />600 East Main Street, Stockton, CA 95202-3029 <br />• cq., a�P Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.org/ehd <br />�IFOR <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: <br />U 0 c A S } S 4- 5 R i L ej <br />Date: <br />' <br />Address: J 791 <br />q <br />/ I c City: I G <br />, �,I t <br />Zip Code: <br />r 3 04 <br />J <br />Owner/Operator: <br />r <br />Telephone: <br />X30 - (j'T <br />Program Element: <br />1 U( Program Record: 5 R b f 3 L <br />I 1. <br />Inspection Type: <br />' <br />SB180 Posted Yes <br />No Permit Posted Yes No Re -Inspection on or After: <br />F613SERVATIONS{{ AND CORRECTIVE ACTIONS <br />crrec <br />C' Cirri 51 <br />fe r:v e r,, lo rs <br />4 <br />01 Q r <br />CC rrtc <br />r' <br />6 r C, 0,ft <br />(,t <br />r <br />Ic o; <br />s AK I C, cl c, j< V(aj <br />0 r eve <br />1: cA <br />Cle A/ Le e <br />re - pacKaxed. <br />• 3 wee C <br />la e. -In. I [- PP ` <br />e enG <br />i <br />/ <br />�P {U <br />Item/Location <br />Temperature <br />Item / Location Temperature <br />Item / Location <br />Temperature <br />Food Safety Certification <br />... _ . __� _ ... :...._.... _... <br />Name: <br />Exp. Date: <br />11 <br />Facility Hot Water Temperature <br />_. __ _._ _........__._ - <br />Hand Sink: of <br />............... Warewashing <br />Chlorine: ppm Heat: <br />duat. mmm.: ppm Other: <br />°F <br />of <br />Warewashin�g Sink: of <br />l <br />Received By/ Title: <br />b1tQA" _ 4 'S <br />/�" <br />EH Specialist: <br />Phon . <br />• 6 J 1 S/ <br />O <br />Time in: <br />Time Out: <br />Page of <br />EHD 16-24 (2n° pg) 11/2/09 FOOD PROGRAM OIR CONTINUATION <br />