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SAN JOAQUIN COUP' ' <br /> ENVIRONMENTAL HEALTH DFr-ARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone: (209) 468-3420 Fax:(209) 464-0138 Web:www.sogov.org/ehd <br /> 'OLIFORI� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 4 14 i, �, Date: I <br /> Address: j 'Z S rp a1'1 k City: (AA_„r Zip Code: c� 2 <br /> Owner/Operator: i G `r /' t')'i �0� _ 1 Telephone: <br /> Program Element: i }; Program Record: -t n /, T 1A Inspection Type: <br /> SB180 Posted Yes No ; y,,(V� Permit Posted Yes No Re-Inspection on or After: <br /> aYE <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> h - � ur flub (jM 6 n QS S I �ngZ-CAO <br /> a ,� 0 - � 1 1 cats a <br /> el- . <br /> t 'rl� <br /> GIN e CXA y'Ufit m 0 - �' 1 ti LA <br /> \N �f <br /> c "WotoM <br /> ct 11 -mss- <br /> P <br /> Item/Location Temperature it /'Location Temperature <br /> ---- — — <br /> Food Safety Certification Facility Hot Water Temperature <br /> Name: Hand Sink: o Chlorine: <br /> F �G ppm Heat: o F <br /> Exp.Date: rZ.Z Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> EH Specialist: Phone: �, 1 .;� - � <br /> Time in: I ; -�h Time Out: �w�' , U 1 Page f <br /> EHD 16-24 (2,d pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />