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SAN JOAQUIN COI. Y <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> . c t Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.slgov.org/ehd <br /> •QGj FORS <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: _ e_ 5 PU CA-- Date: .1_3-I z. <br /> Address: City: ` �1�. Zip Code: p)52_0(4 <br /> Owner/Operator: �9w ICJ `p Telephone: � _2-19-7192-19-7 / <br /> Program Element: -1 Program Record: n �I �.�7Z Inspection Type: i�d <br /> SB180 Posted Yes No Permit Postedl�_Yes No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> O <br /> e n s r_ k-ro orn ✓ <br /> bP10 4- +D F6 <br /> tl -C ct-4.r <br /> Item/Location Temperature Item/Location Temperature <br /> - — -- <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp. Date: Warewashing Sink: of Quat.Amm.: ppm Other: of <br /> Received By/Title: <br /> r <br /> EH Specialist: ) = Phone: <br /> Time in: Qt; `5 Time Out: t C.2 i 1 Pa of <br /> 1 Jv Iff <br /> END 16-24 (21 pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br />