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SAN JOAQUIN COL Y <br /> y� 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 /> �iFoaa <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: FI r► #14 of r1 5 Pw 6 4-- Gr< < I Date: <br /> ddress: dy a 5 �Z a c�L ,e City: Zip Code: 95�Q 7 <br /> Owner/Operator: 4t0r7 7�Manh Q r Telephone: 2_p53 <br /> Program Element: trograhf Record: p 01&6-23 <br /> 1&6-2 & Inspection Type: /1_1Yt� <br /> 8180 Posted Yes D Rermit Posted Yes D I Re-Inspection on or After: /� <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> t u-oh.e r _bou_ 6or <br /> o� a v�-i rs ra a t ��-►-� b <br /> t S 4Y-oo 1�n rl broKe - Ge.c.r <br /> Y_ r la.c.v_ bLn z w s <br /> 12 naki <br /> h o`til-c s Cvz 1� /-a <br /> Y V 1 0 (0'_.+Ce n -):5 "e- <br /> Go <br /> ItemiLocation Temperature Item/Location Temperature <br /> Food Safety Certifiica" Facility Hot Water Temperate °' � > Warewashing <br /> _._. ._ t _ ..._ _ _ y�o__ __-- __.. <br /> Name: Hand Sink: of �Chlorine: ppm 11 Heat: of <br /> Exp.Date: arewashing Sink: of uat.Amm.: ppm Other: of <br /> Received By/Title: - <br /> EH Specialist: Phone: W <br /> Time in: �j Time Out: J f! � Page• of / <br /> EHD 16-24 (2n1 pg) 4/3/13 FOOD PROGRAM OR CONTINUATION <br />