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SAN JOAQUIN COUNTY <br />ENVIRONMENTAL HEALTH DEPARTMENT <br />1868 East HazeIton Avenue, Stockton, CA 95205-6232 <br />Telephone: (209) 468-3420 Fax: (209) 464-0138 Web: www.sigov.orq/ehd <br />FOOD PROGRAM OFFICIAL INSPECTION REPORT <br />Name of Facility: Date: Ll/al 9 AeSici Mir-ir‘t•-' t5a VED , <br />City: Address: .kb . si. pcxirii,- Zip Code: 1•7--.z0G7 NV. C -ir,levl <br />Owner/Operator: Telephone:news ol <br />Inspection Type: Program Element: \bpi program Record: rp orit.t.-.z)9-ti P(444A , <br />SB180 Posted Yes No Permit Posted e j No Re-Inspection on or After: <br />-/ <br />4, OBSERVATIONS AND CORRECTIVE ACTIONS <br />rualik n $cAke.. 'ave,e)s- ITY.1,4,- AINA- jier..,..„4464 vvvo-e- vs, <br />XacerrA c.ev \ Ar,..z .5 ( a 6,t Av wow 44-1A,..../ El 1-,„i,..1+- f,,bds <br />Gmcw 5 e•cyr Av 61 .1.„,i.4.1 . (eeo 4(*v.,' 4r40::." SA( 90 <br />Dv- ‘ e a A i ',J4IY:;'•e rici-k r Cdr,Vrt44-- <br />. 01(' 4t) k 4"-c?r AA I+c 4 t-rAilt- [efe.841% <br />44 <br />Item/Location Temperature Item / Location Temperature <br />Food Safety Certification Facility Hot Water Temperature Warewashing <br />Name: iviAr_ Hand Sink: o F Chlorine: ppm Heat: °F <br />Exp. Date: Warewashing Sink: . Quat. Amm.: ppm Other: °F <br />Received By / Title:14..*c.,._a ... ve_cv.ks50,,tkl._ <br />EH Specialist: _.....----..... Phone:.,...),.?.._ <br />Time in: Time Out: Page of <br />EHD 16-24 (2II, pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION