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�O.PqutN <br /> CSAN JOAQUIN COUI�' <br /> . O <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> • �q... N;P• Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> L/FOR <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: `` r I Date: / j/ /J <br /> Address: f 2 City: -7— C Zip Code: / _3 t <br /> Owner/Operator: WTelephone:�1�e �G <br /> Program Element: J 6 n Program Record: 3 f Inspection Type: orn la <br /> SB180 Posted Yes 2 No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORREC T IVE ACTIONS <br /> A Is fhc jO-_ r ' ►� b ci Ih rC . <br /> r(,1 1 t1 i V del o C 16y) K <br /> 5` C ►I s , 4 • 1 u I We d 10 0 y)r,r r On 4 he 0 hoin e <br /> S4-'s4r,5 5J'& an 1 01 110 W3 n cn- 5er rice <br /> n fA o M 6 do q `' an ' aa 0 s a i c <br /> i VA of.ns <br /> 1^¢ I r O C�+r►S q ; n c+ n <br /> W C44e '440 A ; , - n Ic pe b e l oW, <br /> s 10 eh r Ja r ✓ er 6r <br /> f - CGnr,e I dry,ria 4o Soo C n WICIS > e <br /> , ; d s auAl <br /> o <br /> C?r\ <br /> 4o I <br /> Item/Location Temperature Item/Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: °F Chlorine: ppm Heat: of <br /> Exp.Date: Warewashing Sink: 'F Ouat.Amm.: ppm Other: o f <br /> Received By/Title: <br /> ' a <br /> EH Specialist: Phone: <br /> Time in: (") Time Out: Page of <br /> EHD 16-24 (2n°pg) 4/3/13 l/ FOOD PROGRAM OIR CONTINUATION <br />