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SAN JOAQUIN COU Y <br /> H. � ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> •.; ;p Telephone: (209) 468-3420 Fax: (209) 464-0138 Web:www.sigov.org/ehd <br /> 4L]iapRti <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: L� Date: 3-31- 15 <br /> Address: Q 3 S w � City:6+_C'K--f-0 n Zip Code: of 6 20 <br /> Owner/Operator: U rSVtGI�t �� r 'In 1^ Telephone: o) 5 20 <br /> Program Element: to 11 Program Record: P i�n ( � O , 2 1 Inspection Type: �`2 7 <br /> K8-0posted Yes ❑ Rermit Posted D Yes ❑ I Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> IN•,�-,� <br /> y U'1+r-) LAI, cl 4-C S Y +yoo r i %S Ym + C_a-vt r . <br /> �enki 1p,, Qn -Cr►n n o k Wov- Ie i k-z j-���- l � h.o+ <br /> LA_}m 4- ,r CntiAr a ce <br /> 0i ri ot 4a4--cA+ 6 L, 1 - 9 det <br /> ys <br /> G� L Chi o�-c r <br /> mton R e (rte ►-n on4hS <br /> i e (a-tion n:� 4-�e - -� �✓ <br /> Item/Location Temperature Item 1 Location Temperature ' <br /> Faad Safety CertificationFacility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm Heat: of <br /> Exp. Date: WarTashing Sink: -F uat.Amm.: ppm Other: of <br /> h <br /> Received By/Title: <br /> EH Specialist: Phone: _ I <br /> Time in: •-2-110- 5 Time Out: z: Page of <br /> EHD 16-24 (2n1 pg) 4/3113 FOOD PROGRAM OIR CONTINUATION <br />