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SAN JOAQUIN COU& <br /> Z� ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> cq.. CP Telephone: (209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Og , I-G I Date: U - / Y <br /> Address: I City: Zip Code: q 5 i 31 <br /> Owner/Operator: Telephone: <br /> Program Element: Program Record: Inspection Type: <br /> SB180 Posted Yes No Permit Posted Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> L ,n 1- u e frIfn vele 1z i c' !r3 ;:� �' Io U r S 4-0 r C.f JJ <br /> fOd dF4n S rr,^a Xel R e mz,' t !J• <br /> ; Ler S 1112ra )- /On 144, CGfreC4es�. <br /> �e lin , A q lir WG //s qnd Ce; 1; A /C Cs c 1,41 // <br /> S4 O r a 9 roc/yl G i i I <br /> 4a r beiif 'S os-'l 16 dip t area Ad -iU 4 ;0 ,1 ; A <br /> ' IC <br /> 1 1 h } cc ✓rrj ir. !�r � t ., � � r, r "4'Inv/I <br /> RP 0 A : r V'. <br /> 6 S o o/ c' 'n has i cL7 / ./ . . e <br /> 1 CG, 4'.GYQ . ko,"c ve ICA <br /> /:4fro 14?r SAO / /Zt'. 9,GS KLA a. <br /> ra /0 11 i n 2 wee leS <br /> go 4 h ro g 4,-o,i+'1 S A r- ve 0010 S; '-IK l hie K.S l a <br /> u10 r, 9.0 a ; t ir'N I 1-4c, A, <br /> Jr3- Ccr+7 le ft 'lee �ACKS c.l (iJGl ��r hC (7 <br /> l6 + Serve :.1 4cr►'lq /"e +4 re L4 <br /> Item/Location Temperature Item!Location Temperature <br /> I!"a(A1,S>f � � Glue . 1 - I✓�,+tl'�..� t�L4r } Ji, <br /> tuHlSery u-0%Xir� �� /' 'TraalSon <br /> �rc4%.A �•2-U/dar) elf 7tCA0ISC N q dar) SCJ �l r <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: 1.. y ;n Y� A u4 Hand Sink: of Chlorine: ppm Heat: �F <br /> Exp.Date: _ Warewashing Sink: 'F Quat.Amm.: ppm Other: `F <br /> Received By/Title: <br /> a <br /> EH Specialist: Phone: <br /> Time in: 'J�j t ? Time Out: Gi Page of <br /> EHD 16-24 (2nd pg) 4/3/13 FOOD PROGRAM CIR CONTINUATION <br />