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o�aulN c SAN JOAQUIN COUP• <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> Telephone:(209) 468-3420 Fax:(209) 464-0138 Web:www.sigov.org/ehd <br /> 4L�FOR� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: Date: �- _ _ 3 <br /> Address: 3 E City: ! /� Zip Code: <br /> Owner/Operator: M Telephone: �9 <br /> Program Element: Program Record: PRI( <br /> /117 Inspection Type: S e <br /> B180 Posted Yes No Permit Posted Yes /- No Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> _d s nGl <br /> C 1,e 'z_e.F vr.., r J-�Q_low rv�2 <br /> a," Gt Gc.� /jo7�r d <br /> \tea-- t Lcro r a, <br /> -en ,6vx-cs <br /> t�o r r ;dVV 15)"e - �a s <br /> 8 I`S - <br /> Ginn�i,�-r Y C� r YL-� V,o • /' � c�/�- r S _ � <br /> or, ao C <br /> Item/Location Temperature Item/Location Temperature Item!Location <br /> r Fri d q q I <br /> Food Safety Certification .Facility Hot Water Temperature Warewashing <br /> Name: O Hand Sink: of Chlorine: ppm Heat: 'F <br /> Exp.Date: _ _ arewashing Sink: 'F Quat.Amm.: ppm Other: 'F <br /> Received By/Title: <br /> EH Specialist: I Phone: <br /> Time in: o : D Time Out: Page of <br /> EHD 16-24 (2^"pg) 4/9/12 FOOD PROGRAM OIR CONTINUATION <br />