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,oPa .�oG SAN JOAQUIN COU ' <br /> Q` y+ ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> . �4.., �;;p• Telephone:(209)468-3420 Fax:(209) 464-0138 Web:www.slpov.org/ehd <br /> �l FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: 'T Date: .) _2_'!-I C f <br /> Address: n 7" r C\ � 0. City: 45��� Zip Code: 5-24 <br /> LZ �.l <br /> Owner/Operator: —0 a v) 1` L( m Telephone: Q q(D-b 8(PZ) <br /> Program Element: 1(.0 21 0( ( Program Record: 69-006 (07-404 Inspection Type:r-lo J,H »R, <br /> SB180 Posted i Yes kNo Permit Posted`NYes No Re-Inspection on or After: <br /> f OBSERVATIONS AND CORRECTIVE ACTIONS <br /> G w-tC j 0 Y7cli C. C-" r'P rZ-0 <br /> Lyi etza0Y , <br /> C 4 yw+ 1.104_ -e>I-vsu P 1 5 k_oL _ ka-: l-aey 6�, <br /> 05-!' 616 ,8 O 0'+ Q rxz r U Cs 0,.1z> Le, <br /> '� ro v-%aL L pY ti n-<- b.% n+t t Se5nssu r Ge <br /> OLA- 1 00 12 IQ 07 . <br /> tf_0k-c+ r o+ op 6-e-4- ail�1 <br /> Y2 lRrt C�-e �� Y- <br /> ►'1 OTS: �f we S'►�.IC -e v t�f-h ✓+o w-�1� ct 1-t d . - <br /> Rt rn o UR U s� l-I n da i�.l 1r h a"d Lc_ia s k_,�1�713_ <br /> Item/Location Temperature Item/LocationTemperature <br /> AC <br /> PY' png 1240 n <br /> 020tia r Lnr'"n Is fit <br /> _1A10-_C. +_c I, _ _ <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: ' j Hand Sink: o Chlorine: m Heat: o <br /> ILI � � IGS I � F IQC> PP F <br /> Exp.Date: _ Warewashing Sink: 12 of Ouat.Amm.: ppm Other: of <br /> m- J <br /> Received By/Title: <br /> EH Specialist: Phone: p53- <br /> Time in: I . Time Out: 1 1 1/H Page f <br /> EHD 16-24 (2^a pg) 4/3/13 V FOOD PROGRAM OIR CONTINUATION <br />