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SAN JOAQUIN COUN'. <br /> ENVIRONMENTAL HEALTH DEPARTMENT <br /> 1868 East Hazelton Avenue, Stockton, CA 95205-6232 <br /> �q.• ;P Telephone: (209) 468-3420 Fax: (209)464-0138 Web:www.sigov.org/ehd <br /> �ikoa� <br /> FOOD PROGRAM OFFICIAL INSPECTION REPORT <br /> Name of Facility: // 1 Date: <br /> Address: P L >^ City: Zip Code: <br /> Owner/Operator: J�,, Telephone: <br /> Program Element: Pil� , Program Record: O , t, Inspection Type: <br /> B180 Posted ❑Yes ❑ Permit Posted ❑Yes F,I Re-Inspection on or After: <br /> OBSERVATIONS AND CORRECTIVE ACTIONS <br /> 10 Zc <br /> V rti l ? �, 1 544-4c c4 n d ?. ,a e- <br /> In irk �� i '/ t'✓1u: 1 SSS <br /> /fir I C l s I da r do V <br /> rI, r(1 4A S t be ti, ro 1'11 Uril C4n r1 4,c G1 t <br /> (l ry <br /> CA a r �G �✓lIS + G� S 'Se< <br /> .2.sT re$ <br /> u?o I e ss r occ �. ►1 b r� rrr� t' oe re lar <br /> Pre <br /> ----....... <br /> F, Pre W t tie / i o r -IG' 44.S e, <br /> c I 1 <br /> `r 5 of h _ <br /> rAyco .. �o 5 ci c- <br /> N .1c ct e_ 5 ct re, b c,t ec r n,,,J I ce k e <br /> Item/Location Temperature Item I Location Temperature <br /> Food Safety Certification Facility Hot Water Temperature Warewashing <br /> Name: Hand Sink: of Chlorine: ppm ;Heat: of <br /> Exp.Date: arewashing Sink: ) of uat.Amm.: ppm Other: of <br /> Received By/Title: .. <br /> EH Specialist: Phone: 4 L J 6 <br /> Time in: C. Time Out: Page, of <br /> EHD 16-24(2"d pg) 4/3/13 FOOD PROGRAM OIR CONTINUATION <br /> PE /I is <br />